Mrs.xxx 60years female having diabetes (309) diagnosed before 1 week as a case of diabetic neuropathy , started treatment with insulin before 2days. Now the patient is having both sensory and motor function loss in right lower leg (below knee). Past h/o patient undergone for dental extraction before 1year at that time not diabetic ,patient had pain and tingling sensation in the right lower extremity ×1week. Treatment history-tab .chlorodiazepoxide & Amitryptylline ,tab .glipizide,tab.duloxetine,tab.oxcarbazepine taking the above said tablets for past 2 days and inj .insulin given twice a day for past 2 days ,please go through this case and give your diagnosis.thank you.
It commonly involves both legs and a recent history of an infection should be present to consider it. Since GBS evolves rapidly, if the symptoms remain unilateral for a few days, the ddx of GBS is excluded.
Motor involvement is extremely rare in diabetic neuropathy, but diabetics are more prone to pressure palsy. Assuming the lesion is in the PNS (diminished-absent tendon reflexes) a Nerve Conduction Velocity study would give the characteristic wave of nerve block and demyelination (along with the axonal findings on the sensory nerve due to the diabetic neuropathy). If that's the case, only physical therapy is indicated (along with a "boot" if the patient has foot drop) and the prognosis is good. Cortisone is contraindicated due to diabetes and antiplatelets have been proven ineffective for ischemic pressure palsies.
