Diabetic amyotrophy. A case report

The most familiar neurological affliction associated with diabetes mellitus is a distal symmetrical sensory neuropathy. With that lesion, the physical finding that is especially striking is loss of vibratory sensation, usually in the lower extremities. However, there is another, less common condition associated with diabetes that is more difficult to diagnose. In 1890, Bruns first described an asymmetrical motor neuropathy associated with diabetes mellitus, and more than 150 years later this syndrome was more fully described by Garland and Garland and Taverner, who gave it the name of diabetic amyotrophy. Many think that this is an entirely different lesion, although the two may be seen together. Because there commonly is an association of abdominal or low-back pain and weight loss with diabetic amyotrophy, it may prompt an extensive and frequently invasive search for a spinal or pelvic lesion before the diagnosis is made. The relation of diabetic amyotrophy to so-called diabetic neuropathic cachexia is unclear. The lack of familiarity with this syndrome of physicians, especially orthopaedic surgeons to whom patients with back pain and motor deficits often are referred, may be responsible for misdiagnosis, delay in diagnosis and treatment, and unwarranted medical examinations. We are reporting such a case of diabetic amyotrophy. The correct diagnosis was not entertained until a year after the patient was initially seen, after an extensive series of laboratory procedures.