A Man with Leg Weakness, Pain, and Weight Loss

The glycated hemoglobin level was greater than 14.0% at initial presentation, and he had lost 11 kilograms in the previous year. Weakness was so profound that he had to push himself upstairs in the seated position. Five months later, examination revealed left- greater than right-sided proximal weakness, muscle atrophy, absent reflexes, and fasciculations of his legs. Extensive evaluation, including imaging and testing for malignancy, was largely unremarkable. The disease process was localized to the lumbosacral roots and plexus, so clinicians pursued electrodiagnostic testing to clarify the diagnosis.