ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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Diyabetik Amyotrofik Nevralji
Diabetic Amyotrophic Neuralgia
Received Date : 13 Mar 2019
Accepted Date : 09 Jul 2019
Available Online : 03 Oct 2019
Doi: 10.31609/jpmrs.2019-66025 - Makale Dili: EN
J PMR Sci. 2019;22(3):149-52
ÖZET
Amyotrofik nevralji, akut-subakut başlangıçlı ağrı ve güçsüzlük ile karakterize idiyopatik ve inflamatuar bir nöropatidir. Bu durum, diyabetik hastalarda diyabetik nöropatinin nadir bir formu olarak ortaya çıkmaktadır. Bu çalışmada diyabetik nevralji tanısı koyulan bir hastanın klinik, elektromiyografik ve radyolojik özelliklerini sunmayı amaçladık. Elli sekiz yaşında bayan hasta merkezimize bel ağrısı ile başvurdu. Hastanın anamnezi alındığında; ağrının bir ay önce başladığı ve her iki kalça ve sol alt ekstremiteye yayılım gösterdiği öğrenildi. Vizüel Analog Skalaya (VAS) göre bel ağrısının şiddeti 100 mm olarak ölçüldü. Hasta aynı zamanda 10 senedir diabetes mellitus tanısı olduğunu belirtti. Fizik muayenede, bel hareketleri kısıtlı ve ağrılı idi. Alt ekstremitelerin kas gücü proksimalde 1+/5, distalde ise 2+/5 olarak değerlendirildi. Hastanın elektromiyografik değerlendirmesi alt ekstremite sensöri-motor aksonal polinöropati ve diyabetik amyotrofik nevralji olarak raporlandı. Hastaya 150 mg/gün pregabalin tedavisi başlandı. Tedavi sonrası değerlendirmede bel ağrısı şiddeti VAS değeri 10 mm’ye düştü. Klinisyenler diyabet tanılı ağrı ve güçsüzlüğü olan hastalarda bu patolojiyi göz önünde bulundurmalıdır. Ayırıcı tanıda elektromiyografik incelemeler ve Magnetik Rezonans Görüntüleme (MRG) yarar sağlayabilmektedir.
ABSTRACT
Amyotrophic neuralgia is an idiopathic and inflammmatory neuropathy characterized by acute-subacute onset of pain and weakness. It can rarely occur in diabetic patients as a form of diabetic neuropathy. In this study, we aimed to present clinical, electromyographic and radiological features of a case with diabetic amyotrophic neuralgia. A 58-years-old female patient was admitted to our department with low back pain. Her medical history revealed that the pain had started one month ago and radiated from the low back to the bilateral hips and left lower extremity significantly. Visual Analogue Scale (VAS) score of low back pain was 100 mm. She also reported that she had the diagnosis of diabetes mellitus for score ten years. On physical examination; the movements of the lower back were decreased and painful. The muscle strength of lower extremities were 1+/5 proximally and 2+/5 distally. Electromyographic assesment was compatible with sensory-motor axonal polineuropathy on lower extremity and diabetic amyotrophic neuralgia. A medical treatment consisting of pregabalin as 150 mg daily was administered. Severity of low back pain decreased to 10 mm after the treatment. Clinicians should take into consideration this pathology in patients with diabetes mellitus, pain and weakness. Electromyography and Magnetic Resonance Imaging (MRI) findings can be useful in differential diagnosis.
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