Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Neuropathy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2003

The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument.

OBJECTIVE: The purpose of this study was to develop a questionnaire that measures patients' perceptions of the impact of diabetic peripheral neuropathy and foot ulcers on their quality of life and to assess the psychometric properties of this instrument in a sample of patients with varying severity and symptomatology of diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS: The neuropathy- and foot ulcer-specific quality of life instrument (NeuroQoL), generated from interviews with patients with (n = 47) and without (n = 15) diabetic peripheral neuropathy, was administered to 418 consecutive patients with diabetic peripheral neuropathy (35% with foot ulcer history) attending either U.K. (n = 290) or U.S. (n = 128) diabetes centers. Psychometric tests of NeuroQoL included factor analyses and internal consistency of scales; a series of multivariate analyses were performed to establish its criterion, construct, and incremental validity. Results were compared with those obtained using the Short Form (SF)-12 measure of health-related functioning. RESULTS: Factor analyses of NeuroQoL revealed three physical symptom measures and two psychosocial functioning measures with good reliability (alpha = 0.86-0.95). NeuroQoL was more strongly associated with measures of neuropathic severity than SF-12, more fully mediated the relationship of diabetic peripheral neuropathy with overall quality of life, and significantly increased explained variance in overall quality of life over SF-12. CONCLUSIONS: NeuroQoL reliably captures the key dimensions of the patients' experience of diabetic peripheral neuropathy and is a valid tool for studying the impact of neuropathy and foot ulceration on quality of life.

Aged↗
PubMed1999

Relationship between neuropathy, hypertension and red blood cell Na/K ATPase in patients with insulin-dependent diabetes mellitus.

Hypertension has been proposed as an independent risk factor for diabetic neuropathy. In insulin-dependent diabetic (IDDM) patients suffering from neuropathy, red blood cell (RBC) Na/K ATPase is decreased. Such a decrease might be involved in the physiopathology of hypertension and therefore be the link between hypertension and neuropathy. To confirm this hypothesis, we studied 104 IDDM patients with a long duration of disease by looking at the association between neuropathy and hypertension and by comparing RBC Na/K ATPase activity in subgroups. The independent risk factors associated with neuropathy were hypertension, triglyceride level, diabetes duration and low RBC Na/K ATPase activity. Contrary to our expectations, Na/K ATPase was not decreased in hypertensive patients (294 +/- 16 nmol Pi/mg prot/h vs 303 +/- 9), but those treated with angiotensin converting enzyme (ACE) inhibitor had higher RBC Na/K ATPase activity than those treated with calcium blockers (355 +/- 15 nmol Pi/mg prot/h vs 216 +/- 10). These results confirm the association between neuropathy and hypertension, on the one hand, and neuropathy and decreased Na/K ATPase, on the other, and show that hypertension in IDDM patients was not associated with decreased RBC Na/K ATPase. Moreover, ACE inhibitor treatment in IDDM patients, whether hypertensive or not, was associated with higher levels of RBC Na/K ATPase, which could account for its beneficial effect on diabetic neuropathy.

Adolescent↗
PubMed1999

Neuropathy and quality of life in diabetic continuous ambulatory peritoneal dialysis patients.

Diabetes mellitus is the commonest cause of end-stage renal failure and is associated with considerable morbidity. Neuropathy is one of the most serious complications of diabetes, linked to the incidence of nephropathy and retinopathy. The prevalence of neuropathy increases with age and duration of diabetes. Peripheral sensorimotor neuropathy is the main manifestation of neurological damage in diabetes, while autonomic neuropathy, a devastating complication, is also present in a large number of patients with long-term diabetes. Clinical features of autonomic neuropathy are mainly cardiovascular disorders and abnormal visceral function. One of the most important sequelae of neuropathy is the development of the insensitive foot at risk of ulceration, deformation, Charcot neuroarthropathy, and amputation. Prevention, education, and identification of the at-risk patient are the key elements in managing these severe complications. Dialysis, and mainly peritoneal dialysis, still remains the main renal replacement therapy for end-stage renal disease (ESRD) diabetic patients. It is obvious from many studies that diabetes and its complications are major risk factors associated with poorer survival rates, increased morbidity, and decreased quality of life. Few, if any, data are available specifically evaluating quality of life in continuous ambulatory peritoneal dialysis (CAPD) diabetic patients. Fewer data are available estimating the impact of neuropathy on the quality of life of such patients. Specific studies must be carried out to further investigate quality-of-life issues and neuropathy in this vulnerable group of patients.

Autonomic Nervous System Diseases↗
PubMed1999

Silent myocardial ischemia and cardiac autonomic neuropathy in diabetics.

OBJECTIVE: To evaluate the association of silent myocardial ischemia (SMI) with cardiac autonomic neuropathy in asymptomatic diabetic patients. MATERIAL AND METHODS: Two hundred asymptomatic patients of diabetes mellitus were assessed for evidence of cardiac autonomic neuropathy. Of these, 30 (15 males, 15 females; mean age 44.7 +/- 8.8 years) were found to have cardiac autonomic neuropathy. Thirty (30) age and sex matched diabetic patients (mean age 42.4 +/- 7.6 years) who had no evidence autonomic neuropathy were included in the study as control group. Both the groups of patients were evaluated for SMI by 24 hour ambulatory electrocardiographic (ECG) monitoring. RESULTS: Incidence of SMI was significantly higher in patients with autonomic neuropathy 12/30 (40%) compared to those without 3/30 (10%) p < 0.001. Duration of diabetes was more (13 +/- 1.59 years) in patients with autonomic neuropathy compared to the control group (8.66 +/- 1.55 years) p < 0.001. Serum cholesterol and triglyceride levels were significantly higher in patients with autonomic neuropathy in comparison to control group < 0.05 and < 0.01, respectively. There was no difference in the pattern of SMI in the two groups (p = N.S). CONCLUSION: Cardiac autonomic neuropathy predisposes patients with diabetes mellitus to SMI. Twenty four hour ambulatory ECG monitoring provides useful diagnostic information in early detection and evaluation of SMI in asymptomatic diabetic patients.

Adult↗
PubMed2000

[Metabolic and nutritional neuropathies].

The two main causes of metabolic neuropathies are successively diabetes and chronic renal insufficiency. Diabetic neuropathies include both diffuse polyneuropathies and focal neuropathies. Sensori(motor) polyneuropathy is the most frequent form and different therapeutic trials have been initiated on the ground of the vascular and metabolic factors implicated in its pathogenesis. Autonomic neuropathy is the major cause of morbidity and mortality. In patients with chronic renal failure, the polyneuropathy is improved by renal transplantation. The carpal tunnel syndrome is frequent in hemodialysis patients, and surgery gives the opportunity to look for beta-2-microglobulin amyloid deposits. Among the less frequent causes of peripheral neuropathies in which metabolic factors have been considered, we review hypoglycemia, chronic respiratory insufficiency due to chronic obstructive pulmonary disease, chronic liver diseases, and the polyneuropathy occurring in the critically ill patients with nutritional or metabolic failures. In chronic excessive drinkers peripheral neuropathy is classically associated with thiamine deficiency, but the direct effect of alcohol itself has been discussed. Various vitaminic deficiencies have been responsible for the development of peripheral neuropathies. The clinical forms often associate peripheral neuropathy with myelopathy, and serum vitamin E concentrations should be measured in patients with spinocerebellar disorders. Usually nutritional deficiencies need multivitamins supplementation.

Alcohol Drinking↗
PubMed2002

Association of increased plantar pressures with peripheral sensorimotor and peripheral autonomic neuropathy in Type 2 diabetic patients.

AIM: Diabetic polyneuropathy plays a highly significant role in the pathogenesis of the diabetic foot syndrome. It was the objective of this study to investigate the association of different forms of neuropathy (cardiac autonomic, sensorimotor and peripheral autonomic) with elevated plantar pressures in diabetic patients. METHODS: A total of 103 Type 2 diabetic patients was investigated. High plantar pressure was diagnosed when the total peak pressure was greater than 500 N/m2. Thirty-three participants were identified as patients with high-risk pressure and 70 patients had a mean peak pressure lower than 500 N/m2. All patients underwent a complete medical examination including determination of neuropathy, vascular status and foot pressures. RESULTS: Peripheral sensomotoric (p<0.012) and peripheral autonomic neuropathy (p<0.05) were significantly found more often in patients with high plantar pressures. There was no apparent association between autonomic cardial neuropathy and enhanced foot pressure (p=0.175). CONCLUSIONS: Our data clearly point to a correlation of diabetic neuropathy and higher plantar pressures. Interestingly, while there was a strong association between peripheral measures of neuropathy, no higher incidence of cardiac neuropathy in patients with increased foot pressure profiles was found. We strongly recommend that patients with clinical signs and indices of peripheral neuropathy be monitored by pedobarography for early detection and prophylactic shoe care for preventing the development of a diabetic foot ulcer.

Aged↗
PubMed2003

Does diabetic autonomic neuropathy influence the clinical manifestations of reflux esophagitis?

Diabetic autonomic neuropathy is a common complication of diabetes mellitus and affects every segment of the gastrointestinal tract. Gastrointestinal problems tend to be more common and severe in diabetics compared with the nondiabetic population. In the literature, the prevalence of reflux esophagitis is not known. The aim of this study was to analyze esophagoscopic findings, compare them with esophageal symptoms, and evaluate reflux esophagitis in relationship with autonomic neuropathy. We examined 54 diabetics (15 type 1, 39 type II), 28 males and 26 females, average age 55.4 (95% confidence intervals 52.1-58.8), with duration of diabetes more than 5 (average 15.0; 12.4-17.6) years. All patients completed a structured questionnaire. After overnight fasting, gastroesophageal endoscopy was performed in the morning to establish the presence of reflux esophagitis, using the Los Angeles classification. Cardiovascular autonomic neuropathy was diagnosed with the help of cardiovascular autonomic reflexes (deep breathing, active orthostasis, Valsalva's maneuver) and spectral analysis of heart rate variation. Endoscopic esophagitis was present in 22 (40.7%) diabetics and 10 of them (45 %) also complained of reflux symptoms. Sensitivity of symptoms was 45.5% and specificity was 72%. We found the presence of symptoms of reflux esophagitis in 21 (38.9%) diabetics, but of this group only 10 (47.6%) had endoscopic changes. Autonomic neuropathy was present in 29 patients, 16 (55%) of them had reflux esophagitis and 18 (62%) were positive for reflux symptoms. In the diabetics without autonomic neuropathy, esophagitis was noted in 6 (24%), which reflects a significant difference (p < 0.05). Reflux symptoms were present in 10 (40%) diabetics without autonomic neuropathy, and in comparison with patients who had autonomic neuropathy, the difference was not statistically significant. Thus, reflux eosophagitis is common in diabetic patients, with a prevalence of 40.7%. Reflux symptoms do not have a great diagnostic value in establishing reflux esophagitis. We confirmed a relationship between autonomic neuropathy and the clinical manifestations of reflux esophagitis, but no association with accompanying reflux symptoms. (Tab. 2, Ref. 27.)

Autonomic Nervous System Diseases↗
PubMed2003

Effect of losartan on albuminuria, peripheral and autonomic neuropathy in normotensive microalbuminuric type 2 diabetics.

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitors are emerging as effective agents for preventing microvascular complications of diabetes. Losartan (angiotensin II antagonist) has an antihypertensive efficacy equivalent to ACE inhibitors, however its role in microvascular complications is not yet known. MATERIAL AND METHODS: We studied the efficacy of losartan (50 mg once daily for 12 weeks) on albuminuria, peripheral and autonomic neuropathy in 25 normotensive microalbuminuric type 2 diabetics who were asymptomatic for neuropathy. RESULTS: Mean age was 46.6 +/- 4.34 years with the average duration of diabetes being 8.1 +/- 1.54 years. Albuminuria improved significantly from 54 +/- 9.35 mg/L to 32.8 +/- 25 mg/L (Paired student's t-test, P=0.0005) after therapy. Autonomic neuropathy was observed in 64% while 76% had peripheral neuropathy; but there was no improvement with losartan. The duration of diabetes had a negative correlation with autonomic neuropathy. It also had a similar negative correlation with median and common peroneal nerve motor conduction velocities (Pearson's correlation coefficient, r = -0.53, P<0.01 and r = -0.56, P<0.01 respectively) implying that autonomic and peripheral neuropathy worsen as a diabetic ages. However, no correlation existed between albuminuria and autonomic or peripheral nerve function. CONCLUSION: Autonomic and peripheral neuropathy are highly prevalent in normotensive microalbuminuric diabetic patients. Losartan remarkably improves albuminuria but a similar benefit in autonomic or peripheral neuropathy is not seen over 12 weeks. The future may see a defining role for losartan in microvascular complications in normotensive diabetics.

Adult↗
PubMed2005

Evaluation and prevention of diabetic neuropathy.

Diabetic neuropathy is a debilitating disorder that occurs in nearly 50 percent of patients with diabetes. It is a late finding in type 1 diabetes but can be an early finding in type 2 diabetes. The primary types of diabetic neuropathy are sensorimotor and autonomic. Patients may present with only one type of diabetic neuropathy or may develop combinations of neuropathies (e.g., distal symmetric polyneuropathy and autonomic neuropathy). Distal symmetric polyneuropathy is the most common form of diabetic neuropathy. Diabetic neuropathy also can cause motor deficits, silent cardiac ischemia, orthostatic hypotension, vasomotor instability, hyperhidrosis, gastroparesis, bladder dysfunction, and sexual dysfunction. Strict glycemic control and good daily foot care are key to preventing complications of diabetic neuropathy.

Diabetic Neuropathies↗
PubMed2005

[Diabetic neuropathy--a clinical review].

BACKGROUND: Diabetic neuropathy is an often overlooked common complication of diabetes. METHODS: This review is based on papers identified on Medline and our own clinical experience. RESULTS AND INTERPRETATION: Diabetic neuropathies can be classified as reversible or chronic. The most common type is the chronic, progressive distal symmetric polyneuropathy where sensory symptoms in the lower limbs dominate. These patients often lose their protective sensibility and are at risk of foot ulcers and amputations; distressing pain is another symptom of this disorder. Autonomic neuropathy is often a feature of progressive polyneuropathy, but is rarely symptomatic. Mononeuropathies affecting femoral, truncal or ocular nerves are among the reversible neuropathies of diabetes. Distal symmetric diabetic neuropathy is very common; overall prevalence among diabetic patients is around 20-30%. The prevalence increases with the duration of the disease as well as with poor glycaemic control, height and age. The pathogenesis of diabetic neuropathies is not clear, but possibly involves a complex of metabolic factors inducing nerve ischaemia. We recommend yearly screening for most diabetic patients with a simple screening instrument consisting of four questions and four simple tests. Tight glycaemic control has been shown to protect against or delay the occurrence of neuropathy. Tricyclic antidepressants are still the drugs of choice against painful diabetic neuropathy, but gabapentin and tramadol are new alternatives.

Amitriptyline↗
PubMedDate not supplied

[Contribution of electroneuromyography to the evaluation of neuropathy in diabetic patients].

OBJECTIVE: To determine the type and the frequency of diabetic neuropathy, diagnosed by electroneuromyography, in patients with type 2 diabetes mellitus, and the correlation between the neuropathy diagnosis and clinical symptoms. MATERIAL AND METHODS DESIGN: Cross-sectional descriptive and correlative of patients with diagnosis of type 2 diabetes mellitus, sent for electroneuromyography study in 2000. Study place: Laboratory of electrodiagnosis of the Unidad de Medicina Física y Rehabilitación Región Norte. Measuring: Electroneuromyography was performed, and the type and frequency of the diabetic neuropathy, as well as the presence of clinical systematization, according to the initial diagnosis, were assessed. Furthermore, sex, occupation, and medical unit of reference were identified. ANALYSIS: Measures of central tendency and dispersion, as well as association by means of quadruple correlation ratio were considered. RESULTS: 219 electrodiagnostic studies were carried out in patients with type 2 diabetes mellitus, of which 152 were males. The age average was of 54.3 +/- 8.9 years old. The prevailing occupation was that of housewives with 128. The references of the Hospital General de Zona 24 were 39; those of Unidad de Medicina Física y Rehabilitación Región Norte were 32, and those of the Hospital General de Zona 98 were 28. There was a presence of clinical systematization in 186 (84.9%) patients. The electroneuromyography diagnosed diabetic neuropathy in 174 patients, of which 89 correspond to neuropathy due to segmental demyelination, and 85 to mixed neuropathy; in 21 patients, the electroneuromyography was normal. Of the 186 patients with clinical systematization, the electroneuromyography was positive in 170, with r = 0.70. CONCLUSIONS: The prevalence of diabetic neuropathy in patients with type 2 diabetes mellitus is of 80%, the type of variety is of segmental demyelination in 51% and of mixed type in 49%. There is a high correlation between the clinical diagnosis of diabetic neuropathy and the confirmation by electroneuromyography.

Cross-Sectional Studies↗
PubMed1990

Gender differences in the associated complications among type-II diabetics with peripheral neuropathy.

Diabetic neuropathy is an intriguing problem both for the patient and the clinician, however the clinical characteristics of type-II (non insulin-dependent) diabetics with peripheral neuropathy with special reference to gender differences is not paid much attention. We studied peripheral neuropathy and related complications in 179 type-II diabetics. Peripheral neuropathy was noted in 46 of 111 men and in 46 of 68 women. The age group of subjects did not differ significantly. Duration of diabetes differed between the groups with (n = 46) and without (n = 65) peripheral neuropathy (expressed in years and as mean +/- S.E: 7.7 +/- 0.7 vs 5.5 +/- 0.7; t = 2.2; P less than 0.05) in men, whereas in women it was not significant. Higher proportion (62.5% of 24) of men with proteinuria had neuropathy. Similar findings in women were not different. We conclude i) a large percent (51.4%) of the type-II diabetics had peripheral neuropathy than realised ii) duration of diabetes and proteinuria are important risk factors associated with neuropathy especially in men and iii) the gender differences need further clinicopathologic evaluation.

Blood Glucose↗
PubMed1985

[Abnormalities of 24 hour (Holter) ECG monitoring in diabetics: involvement of cardiac autonomic neuropathy and/or insulin therapy].

In order to detect evidence of cardiac autonomic neuropathy, 24-hour continuous electrocardiographic monitoring was carried out on fifty-one diabetic patients (thirty-one IDD, twenty NIDD) and twenty-two healthy controls taking no treatment which could alter the heart rate. In the diabetic patients the minimum 24-hour heart-rate and the mean sleeping heart rate were significantly higher, and the maximum 24-hour heart rate and the ratio [(maximum-minimum heart rates)/minimum heart rate] were significantly lower. Evidence in one diabetic of cardiac autonomic neuropathy was found only as the difference (maximum-minimum heart rates). This index was found to be below 38/min (mean-2 SD of the controls) in seven diabetics, but only one of the nine diabetics with signs of autonomic neuropathy had this abnormal index. The mean values for the minimum and the mean sleeping heart rates were high in the IDD with or without signs of peripheral neuropathy and without signs of autonomic neuropathy but were not high in IDD with signs of autonomic neuropathy. These findings suggest the presence of cardiac autonomic neuropathy in diabetics. However, the possibility of insulin-induced tachycardia should be considered this tachycardia is probably related to stimulation of the sympathetic nervous system, which would explain the absence of abnormalities in IDD with autonomic neuropathy.

Adult↗
PubMed1994

[123I-MIBG myocardial scintigraphy in diabetic patients: association with autonomic neuropathy].

123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed in 20 diabetic patients (NIDDM) and 8 control subjects to investigate the association between clinical autonomic nerve dysfunction and myocardial accumulation of MIBG. We used coefficient variance of R-R interval (CVR-R) as a index of the autonomic neuropathy and categorized diabetes into two groups (CVR-R > or = 2.0: non-autonomic neuropathy. CVR-R < 2.0: autonomic neuropathy). In planar imaging studies, heart to mediastinum MIBG uptake ratio (H/M) was calculated on both early and delayed images. The washout ratio of 123I-MIBG in the heart (%WR) was also obtained using myocardial tracer activity on the both images. Mean value of these indices in diabetic group did not reveal any significant difference with the value in the control group. On the SPECT images, low uptake was observed in the posterior-inferior wall with normal uptake of 201Tl in diabetic patients with non-autonomic neuropathy. These areas extended in patients with autonomic neuropathy. The mean value of count ratio of posterior-interior to anterior wall (posterior-inferior/anterior ratio: PI/A) in the diabetic autonomic neuropathy group was significantly higher than in the control group on the both early and delayed images. And the mean value of regional %WR in the posterior-inferior wall calculated by the both MIBG SPECT images was significantly higher in the non-autonomic neuropathy group than in the control group. In the diabetic patients, retention mechanism of 123I-MIBG was considered to be involved at an early stage without autonomic nerve dysfunction clinically. As autonomic neuropathy progressed severely, uptake mechanism was also supposed to be involved. Therefore, 123I-MIBG myocardial scintigraphy was useful for early detection of cardiac sympathetic nervous dysfunction in diabetic patients.

3-Iodobenzylguanidine↗
PubMed1995

Influence of diabetic neuropathy on skin microcirculation assessed by transcutaneous oxymetry.

Skin microcirculation was investigated in 45 patients with long term diabetes and with severe, moderate or no neuropathy, and in 15 controls. Transcutaneous oxygen pressure (tcPO2) measurements on the forefoot were performed at 37 degrees C to assess local capillary flow at rest, during leg dependency and reactive hyperaemia, and also at 44 degrees C, including the response to oxygen inhalation. TcPO2 (37 degrees C) at rest was significantly elevated with an increasing degree of neuropathy (Controls: 4.8 +/- 3.7; patients without neuropathy: 4.2 +/- 2.9; with moderate neuropathy: 6.0 +/- 2.9 (p < 0.01); with severe neuropathy: 7.2 +/- 4.2 mmHg (p < 0.001)). Leg dependency resulted in a decrease of tcPO2 in the controls, while an increase was observed in 18.6% of the measurements in patients, reflecting a disturbed vasoconstrictor response. Regardless of neuropathy, absolute tcPO2 values during reactive hyperaemia were reduced in all patient groups as well as tcPO2 (44 degrees C) and its increase during oxygen breathing. Diabetic neuropathy is likely to increase local capillary flow, while the other differences to healthy controls may be contributed to a microcirculation disorder independent of neuropathy.

Adult↗
PubMed1995

Abnormalities in gallbladder dynamics of type 1 (insulin-dependent) diabetic patients with autonomic neuropathy.

The aim of this study was to evaluate gallbladder dynamics in insulin-dependent diabetic patients with and without autonomic neuropathy. Gallbladder dynamics was studied by a scintigraphic method after a test meal in 26 insulin-dependent diabetic patients and 10 normal individuals. The presence and severity of autonomic neuropathy were defined according to the number of abnormal cardiovascular reflex tests: absent (no abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the beginning of gallbladder emptying was longer (P = 0.01) in diabetic patients with mild (N = 11, 12.1 +/- 7.6 min) and severe neuropathy (N = 8, 11.0 +/- 10.6 min) than diabetic patients without autonomic neuropathy (N = 7, 3.9 +/- 4.4 min) and controls (N = 10, 4.8 +/- 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8, 5.1 +/- 3.3%/min) than diabetic patients with mild (N = 11, 2.0 +/- 1.0%/min) or without autonomic neuropathy (N = 7, 1.8 +/- 0.8%/min) and controls (N = 10, 2.6 +/- 1%/min). Thirty-two percent of the diabetic patients with autonomic neuropathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlation of ejection rate with the presence of these symptoms (biserial point correlation test = 0.67, P < 0.01) was also observed. These data suggest that insulin-dependent diabetic patients with autonomic neuropathy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal symptoms.

Adult↗
PubMedDate not supplied

Tomaculous neuropathy with unusual clinical aspects.

Tomaculous neuropathy represents the morphological substrate of the recurrent familial neuropathy with liability to pressure palsies. Some ultrastructural changes characterizing the tomaculous neuropathy can occur as incidental aspects in other different neuropathies. Few tomaculous neuropathy cases with clinical aspect of chronic polyneuropathy without paretic episodes have been mentioned in the literature. In the present work, we report four cases who offered the morphological surprise of a true tomaculous neuropathy with 15-37% of the teased fibres bearing tomaculae sized: 55-106 microns/20-23 microns, on the background of a demyelinating neuropathy with 25-56% of the teased fibres showing segmental de- or remyelination. The clinical and electrophysiological diagnoses of these 4 patients were: HSMN type I (2 cases), HSMN type VIII (polyneuropathy associated with a cerebello-extrapyramidal syndrome -1 case), and a neurogenic scapuloperoneal syndrome (1 case). The specificity of the tomaculous neuropathy is discussed.

Adolescent↗
PubMed1998

Malignancy and sensory neuropathy of unexplained cause: a prospective study of 51 patients.

OBJECTIVE: To investigate the frequency of cancer developing in patients with peripheral sensory neuropathy of unexplained cause. DESIGN: Prospective study. SETTING: A neurologic unit in a general hospital. METHODS: Following the diagnosis of neuropathy, we searched for occult malignancy. This search was repeated together with neurologic evaluations every 6 months thereafter. Patient recruitment began January 1, 1988, and ended December 31, 1995. The end point of the study was December 31, 1996. RESULTS: In the study period, we observed 363 patients with peripheral sensory neuropathy. Of these, 53 patients without any identified cause of neuropathy were invited to participate in the study. Of the 53, 2 patients refused. Thus, we examined and followed up 51 patients, 42 men and 9 women, with a mean age of 64.5 years (range, 19-80 years). The range between the onset of neurologic symptoms and the diagnosis of neuropathy was 2 to 72 months (mean, 13.9 months). The follow-up period ranged from 14 to 94 months (mean, 51.4 months). In 18 patients (35.3%) (16 men and 2 women) whose mean age at diagnosis of neuropathy was 66.5 years. malignant growths were found 3 to 72 months (mean, 27.4 months) after the onset of the neuropathy. The cancer was in the liver in 4 patients (all had a primary hepatoma), the bladder in 3, the lymph nodes in 3 (all with non-Hodgkin lymphoma), the prostate gland in 2, the lungs in 2 (small cell lung cancer in both), the breast in 1, the pancreas in 1, the sublingual gland in 1, and the bone in 1 (a metastatic sarcoma). CONCLUSIONS: More than one third of the patients with peripheral sensory neuropathy of unexplained cause developed cancer without any predominating type of malignancy.

Adult↗