Table 9

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
    ▸ 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 examinationProtein value often raised
Only helps if the clinical picture is unusual
    ▸ Nerve biopsyRarely helps management
Microvasculitis and endoneurial mononuclear cell infiltration found in the intermediate cutaneous nerve of the thigh and also in the sural nerve