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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic myelopathy occurred in 41% of 75 consecutive, unselected diabetic patients in an autopsy study; clinical peripheral neuropathy occurred in 13%, and histologic radiculopathy in 21%. Infection represented 2.7% of the cord lesions. Posterior column demyelination, seen in 27%, apparently has the same metabolic-toxic origin as diabetic neuropathy and radiculopathy; it is an independent lesion, not a secondary manifestation of peripheral demyelination. It occurs slightly more frequently in those with juvenile-onset diabetes. Spinal cord infarcts, seen in 19%, are related to anteriolar sclerosis of the intrinsic vessels of the spinal cord. They have a higher incidence in diabetics than in a nondiabetic aging population, show a predilection for the white matter, and are usually small. The myelopathy is not related to patient age or duration of diabetes. It is often clinically occult.
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PMID:Diabetic myelopathy. 58 Nov 51

Neurological complications in the light of their clinical and topographical pattern are discussed with regard to the literature and 40 personal cases. Peripheral neuropathy is the most common (average frequency 26%). The main clinical, anatomical, histological and pathogenetic features of polyneuritis in diabetes are illustrated. Diabetic amyotrophy is a true clinical entity, though its site (neural or muscular) and pathogenesis are still the subject of discussion. Cranial nerve damage (oculomotor paralysis in particular) has the typical clinical, anatomical and histological picture of peripheral forms. Myelopathy leads to three distinct anatomical and clinical patterns: pseudo-tabes caused by degeneration of the roots and posterior cords; chronic anterior poliomyelitis due to degeneration of the cells of the anterior cornua; myelosis attributable to combined degeneration of the posterior and anterolateral cords. The main features of encephalopathy and the relation between epilepsy and diabetes are also examined.
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PMID:[Neurologic complications of diabetes mellitus]. 64 15

The neurologic manifestations most frequently described in association with diabetes are caused by involvement of the peripheral nerves and nerve roots. Whether there is also a specific central nervous system involvement has not been well documented. Pseudotabes diabetica and diabetic amyotrophy probably can be explained on the basis of severe neuropathy or radiculopathy. According to fairly recent studies, however, both myelopathy and encephalopathy may be part of the diabetic process. In the cases of myelopathy, there are degeneration of the long tracts and areas of demyelination with gliosis, as well as microinfarcts. In the cases of encephalopathy, there are degeneration of ganglion cells and nerve fibers in the cerebrum, brain stem, and cerebellum; cell loss, demyelination and gliosis; and infarction secondary to severe angiopathy.
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PMID:CNS manifestations of diabetes mellitus. 83 75

A case of Torulopsis glabrata osteomyelitis of the thoracic spine producing spinal cord compression and myelopathy is reported. The patient displayed several of the predisposing factors to T. glabrata infection, including diabetes mellitus, a history of abdominal surgery, and intravenous catheterization with hyperalimentation. The patient was successfully managed with surgical decompression, debridement, and curettage of the affected bone, postoperative immobilization, and systemic amphotericin B therapy. Her pain was relieved, spinal cord function recovered, and the vertebrae healed uneventfully. T. glabrata osteomyelitis is a rare and unpredictably progressive infection. This case demonstrates that it requires prompt therapy and close observation.
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PMID:Torulopsis glabrata vertebral osteomyelitis. 152 Sep 98

As many as 43 patients suffering from diabetes mellitus associated with the clinical manifestations of diabetic neuropathy underwent ++clinico-electromyographic and immunologic examinations. The control group comprised 30 practically healthy persons of the same age. The electromyographic++ examination included measurements of the rate of wave spreading in motor fibers of the limb nerves in the distal and proximal parts (in accordance with the F-wave), a study of H-reflex from the musculus soleus of the leg together with M-response of hand and foot muscles. The immunologic examination consisted in measurements of different class immunoglobulins in the blood serum. Based on the electromyographic findings, 3 groups of patients were distinguished: group I included patients with primary injury to the myelin membrane of the nerves; group II was made up of patients with primary injury to the axon, and group III of patients with concomitant injury to the nervous membranes and axons. There was a significant elevation of the concentration of anti-myelin activity possessing IgM in the blood serum of patients belonging to groups I and III, which attests to the involvement of the immunopathological mechanism into myelopathy development.
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PMID:[Informative value of complex electromyographic and immunologic examinations of patients with diabetic neuropathies]. 165 86

The relative percentage of patients over 60 years who underwent operations in our clinic has greatly increased from 18% in 1874 to 27% in 1989. Postoperatively, difficulties may also result from additional medical problems, which may be cardiovascular, pulmonary, metabolic (especially diabetes mellitus), increased thromboembolism in origin as well as from the reduced tendency to neurological recovery in elderly patients. On the other hand, advances in diagnostics and surgical treatment often make it possible to help even these patients effectively today. The clinical pictures which are especially frequent in our hospital are specified below. Disc herniations: Soft nucleus-pulposus herniations occur in every age group. In elderly patients, the osseous constriction of the lumbar canal (especially by spondylarthrosis) often leads to spinal claudication. Functional myelography with myelograms taken in the sitting and the standing position is important for preoperative appraisal. On the basis of the clinical/neuroradiological findings, it may be decided whether a selective or an extended decompression is necessary. Larger-scale decompressions are mostly possible in this age group without postoperative instability, with good results in more than 80% of the cases. In our clinic, anterior microsurgical decompression without graft is the most frequently used procedure in cervical disc herniations/spondylosis, a method which is well tolerated by spinal cord and nerve roots: 75% simple anterior discectomies/spondylectomies compared to only 25% classical Cloward operations with bone grafts. We use intervertebral bone grafts only in severe spondylosis and/or instabilities, if necessary in combination with metal plates (e.g. in the context of cervical myelopathy). Craniocerebral injuries: Epidural hematomas and CSF fistulae, but also circumscribed space-occupying contusions have a relatively favorable prognosis in every age group. The older the patient, the more serious is the acute subdural hematoma, which is often associated with extensive contusions, although surprisingly good recoveries are occasionally possible postoperatively even here. Detailed scrutiny of all prognostically relevant factors is important. In borderline situations we give the patient a chance in order to take later action, depending on the course. Chronic subdural hematomas are especially frequent and readily dealt with surgically in patients over 60 years. The simple borehole drainage to the outside is often sufficient. In extensive excreting membranes, which are especially frequent in elderly patients, we prefer today a subdural-peritoneal drainage for six to eight weeks to the very much more burdensome craniotomy: The relatively simple operation allows an early mobilization and almost always a prompt healing. Hydrocephalus male resorptivus is also very much more frequent in this age group.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Neurosurgery in old age. I: Significance of the problem--herniated disk, spinal canal stenosis--craniocerebral injuries--chronic subdural hematoma--resorptive hydrocephalus]. 174 88

Postmortem examination of 21 patients showed a vacuolar myelopathy resembling that associated with the acquired immunodeficiency syndrome. Underlying diseases included six cases of leukemia or lymphoma, five of carcinoma, three of systemic lupus erythematosus, two of chronic lung disease, and one each of cadaveric renal transplant, cirrhosis, diabetes, hemophagocytic syndrome, and viral encephalitis. Fourteen patients were on long-term steroid therapy and 10 of these also had immunosuppressive chemotherapy. No patient had the acquired immunodeficiency syndrome, although one received blood transfusions in 1978. Signs and symptoms consistent with myelopathy included paraparesis in seven patients, ataxia in one, and bilateral extensor plantar reflexes in one. Microscopic examination showed vacuolation in spinal cord white matter primarily located in posterior and lateral columns. Lipid-laden macrophages and axonal changes were proportional to the severity of the vacuolation, which was severe in five patients, moderate in 10, and mild in six. Eight patients had coexistent viral diseases elsewhere in the central nervous system, but viral-associated antigens or genomic material was not found in regions of vacuolated spinal cord white matter. Although the etiology of these myelopathies is unknown, their association with immune suppression and coexistent viral infection of the central nervous system suggests that an opportunistic viral infection may be important.
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PMID:Idiopathic myelopathies with white matter vacuolation in non-acquired immunodeficiency syndrome patients. 186 65

A 66-year-old female suffering from HTLV-1 associated myelopathy (HAM) for more than 30 years was hospitalized because of memorial impairment, deafness, dysarthria, dysphagia, and complete paraplegia. She first noticed stiffness and weakness of the right leg at 35 years of age. Gait disturbance was slowly progressed and complete paraplegia developed 18 years later. Neurological examinations on admission revealed that she was bedridden with decubitus, mental deterioration (pre-dementia of subcortical type), bilateral optic nerve atrophy, severe sensory-neural deafness, dysarthria, complete paraplegia, and marked neurogenic bladder. Laboratory data showed mild normocytic anemia and moderate diabetes mellitus. Anti-HTLV-1 antibody titers in serum and CSF were 78,192X and 1,024X, respectively (PA method). Serum levels of soluble IL-2 receptor was markedly elevated (2,200 U/ml). Peripheral blood lymphocytes showed spontaneous proliferation when cultured for 5 days (3H-thymidine uptake; 45,285 cpm/5 X 10(4) cells). MRI examinations of the spinal cord disclosed a predominant atrophy of lower thoracic cord without any compressive lesions. Brain MRI showed diffuse high intensity lesions of the periventricular area on T2 weighted images. Such abnormalities were predominantly found in fronto-parietal region and were quite similar to those of leuko-ariosis. Single photon emission CT using 123I-iodoamphetamine showed hypoperfusion of cerebral white matter on delayed image. It has been reported that intellectual impairment and brain atrophy are not usually seen in HAM patients. The present case, however, shows that such abnormalities of the central nervous system could occur in HAM patients with a long duration of illness.
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PMID:[A case of HTLV-1 associated myelopathy progressed in course over 30 years]. 189 70

Clinical signs of spinal cord involvement in diabetes mellitus have gained very little attention in the past four decades. On the other hand many pathological studies have shown spinal cord lesions in diabetic patients. We report 12 diabetic patients with clinical signs of myelopathy which, per exclusion, could be explained only as related to diabetes mellitus. Posterior column lesions were more common than corticospinal tract involvement. All our patients had combined peripheral sensory polyneuropathy with myelopathic signs. The combination of peripheral neuropathy, disturbed sense of position and/or vibration with pyramidal signs is highly suggestive of diabetic myelopathy with polyneuropathy. Even though myelopathy is not common in diabetic patients, it is one of the most debilitating neurological complications of diabetes mellitus. We believe that there is enough pathological and clinical evidence to accept the concept of diabetic myelopathy, especially with its prognostic and rehabilitative implications.
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PMID:Myelopathy as a complication of diabetes mellitus. 206 Oct 17

A 67-year-old man with non-insulin-dependent diabetes mellitus progressively developed, over a 2-year period, lower extremity sensory and motor defects associated with impaired bladder function and perineal and perianal sensation related to a disease of the conus medullaris extending from T12 to S5. The magnetic resonance imaging scan suggested myelomalacia and the diagnosis of progressive necrotic myelopathy was confirmed by surgical intervention.
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PMID:Progressive necrosis of the conus medullaris: magnetic resonance imaging and surgical findings. 237 77


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