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Lumbosacral radiculoplexus neuropathy (LRPN) is an acute or subacute painful neuropathy that is probably underrecognized; in diabetic patients, this condition has been termed “diabetic amyotrophy.” LRPN is thought to be caused by a microvasculitis with ischemic nerve injury involving the lumbosacral plexus and nerve roots. In this report, Mayo Clinic researchers presented 59 cases diagnosed during a 15-year interval; all patients were seen by neurologists and had electrophysiologic testing.
Median age at diagnosis was 70; two thirds of patients had type 2 diabetes. Nearly all patients had painful lower-extremity presentations and muscle weakness, but a few cases were sensory-predominant. Presentations usually were unilateral; when involvement was bilateral, clinical findings generally were asymmetric. Involvement was more often proximal than distal (but sometimes both). Cervical or thoracic involvement also occurred in several cases.
Ng PS et al. Lumbosacral radiculoplexus neuropathy: Incidence and the association with diabetes mellitus. Neurology 2019 Mar 12; 92:e1188. (https://doi.org/10.1212/WNL.0000000000007020)
Comment
The authors estimate the incidence of LRPN to be about 4 cases per 100,000 in Olmstead County, Minnesota (where Mayo Clinic is located); thus, it appears to be more common than inflammatory neuropathies, such as Guillain-Barré, which are more widely known to most clinicians. Note that poor diabetes control is not a prerequisite for developing diabetes-related LRPN; it has been described when previously uncontrolled diabetes recently has been brought under good control.