Diabetic lumbosacral radiculoplexus neuropathy (Bruns-Garland syndrome): clinical features and investigations
| CSF, cerebrospinal fluid; DSDP, diabetic symmetric distal polyneuropathy; EMG, electromyelogram; | |
| NCS, nerve conduction study. | |
| Clinical features | |
| ▸ Males more frequently affected than females | |
| ▸ Pain: | Severe, affecting lower back, buttocks or anterior thighs, burning and aching in quality; worse at night |
| ▸ Weakness: | Follows pain within a matter of a few days to several weeks and usually unilateral at onset. Later may be bilateral but asymmetric. Mainly proximal, but not uncommon for distal muscles to be involved |
| May slowly progress over several weeks | |
| ▸ Weight loss: | May be dramatic (>10–20 kg) |
| ▸ Prognosis is reasonable: recovery is heralded by stabilisation of body weight and resolution of pain. Muscle strength improves slowly over many months, but a number of patients never regain normal lower limb strength | |
| Investigations | |
| ▸ EMG/NCS: | Denervation changes in paraspinal, proximal and distal leg muscles |
| There is often an associated DSDP | |
| Lower limb f wave latencies may be more prolonged than usually seen in DSDP | |
| ▸ CSF examination | Protein value often raised |
| Only helps if the clinical picture is unusual | |
| ▸ Nerve biopsy | Rarely helps management |
| Microvasculitis and endoneurial mononuclear cell infiltration found in the intermediate cutaneous nerve of the thigh and also in the sural nerve | |