Kas 3-13E: Patient with pains, insensitivity and weakness of lower

Course 3; Case 13
Kas 3-13E: Patient with pains, insensitivity and weakness of lower extremities
59 years old female, former secretary, now retired. Admitted for a gradual loss of motricity
and loss of sensitivity in lower extremities, accompanied by severe pain. Disturbing are in
particular dysaestesias in the night.
Family history: mother died in 68 on stroke, father died at 72 on myocardial infarction. Both
suffered diabeters mellitus 1st type.
Personal history: Diabetes mellitus 1st type, treated by Insulin from 44 years of age, smoker
10 cigarettes per day, no hypertension.
Present illness: In the last year she used to feel pins and needles and twingling in both lower
extremities, lasting usually tens of minutes. They occurred first twice a week and used to
wake up the patient. Gradually these pains became every day, were felt also in quiet. A
difficulte walking followed, due to pains in the soles and next also weakness of both lower
limbs. In the last month the whole state worsened substantially.
Neurological finding (only substantial or pathological findings): Normal findings on cranial
nerves. Meningeal signs negative.
Normal motion and force on upper extremities, but C5-8 reflexes are low, pyramidal spastic
signs are negative, once upon a time paraestesias on upper extremities.
Abdominal reflexes low, till non-responding bilaterally
Areflexia L2-S2, spastic pyramidal as well as extinction signs are negative on both sides.
Hypaestesia of stockings like shape with upper border in the half of calves, night and quiet
dysaestesias and paraestesias, muscle power weakened down 3 - 4 degree.
Paraclinical examinations:
Laboratory: subcompensated glycemia, otherwise fully negative
EMG examination envisaged
Questions and tasks:
What type of neuropathy do we encounter here?
What is the principal of diabetic neuropathy?
Other etiologies of neuropathy?
What is most important for the compensation of diabetic neuropathy from the
pathophysiological point of view?
5. Pathology: acquired neuropathies
6. Complications of diabetes, origin and consequences