Diabetic Amyotrophy/Bruns Garland syndrome - (radiculo)plexitis or primary muscle disease?

[IonClaws]

Hey everyone - PGY-1 Neurology intern here, confused about the topic in title of thread.

I've been asked to look up diabetic amyotrophy - and various sources (i.e. medscape and uptodate) appear to classify this disease as either a pure plexopathy of the lumbosacral plexus, or a mixed radiculo-plexopathy in the same area. In either case, there is proximal neuropathic pain and proximal muscle weakness of the lower extremities. Sensory deficits usually are absent and if present, indicate the concomitant presence of another neuropathy (most likely also diabetic in nature). NCS/EMG usually indicates a neuropathy rather than a primary myopathy.

My senior appears to disagree with this and says the primary cause isn't the nerves - but I can't find anything that localizes the problem anywhere but the nerves. I'm hesitant to correct him due to hierarchy and whatnot, being just an intern and all.

So...is this a primary neuropathy? I'm not sure who to believe...

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[deathmerchant]

Hey everyone - PGY-1 Neurology intern here, confused about the topic in title of thread.

I've been asked to look up diabetic amyotrophy - and various sources (i.e. medscape and uptodate) appear to classify this disease as either a pure plexopathy of the lumbosacral plexus, or a mixed radiculo-plexopathy in the same area. In either case, there is proximal neuropathic pain and proximal muscle weakness of the lower extremities. Sensory deficits usually are absent and if present, indicate the concomitant presence of another neuropathy (most likely also diabetic in nature). NCS/EMG usually indicates a neuropathy rather than a primary myopathy.

My senior appears to disagree with this and says the primary cause isn't the nerves - but I can't find anything that localizes the problem anywhere but the nerves. I'm hesitant to correct him due to hierarchy and whatnot, being just an intern and all.

So...is this a primary neuropathy? I'm not sure who to believe...

There is no clear answer to this one. Majority of evidence points it to be a mixed radiculo-plexopathy but there are cases with just abnormal motor end plates with axonopathy and few with myopathy.

I remember seeing a case series of EMG/NCS in patients with DA, several years back. If there is a new similar study, that would be the best evidence or place to look for, esp if someone followed it with biopsy/autopsy.