Nondiabetic Neuropathies More Common In Patients With Diabetes

In addition to specific neuropathies, patients with diabetes appear more prone to develop some types of neuropathy than patients without diabetes.

Increased Liability to Pressure Palsy

Pressure palsy is more common in diabetic individuals (52). Carpal tunnel syndrome occurs in 12% of diabetic patients (53) and the incidence of ulnar neuropathy because of microlesions at the elbow level is high in patients with diabetes too (54).

Acquired Inflammatory Demyelinative Polyneuropathy

Inflammatory, predominantly demyelinative neuropathy also must be differentiated from diabetic polyneuropathy, and may occur with a greater frequency in this population. This diagnosis must be suspected when an acute or subacute, often predominantly motor, demyelinating polyneuropathy occurs in a patient with diabetes. Electrophysiological features are those of a demyelinating neuropathy (55). The course and response to treatments are the same as in patients without diabetes.

Mucormycosis

This rare condition is an acute disease that affects successively the air cavities of the face, the orbit, and the brain, in relation to proliferation of a fungus of the class Phycomyceta (56). In 36% of cases it is associated with diabetes, especially in patients with diabetes with ketoacidosis. After an episode of rhinological involvement with epistaxis, a patient with diabetes in acidosis manifests violent headaches and orbitonasal pains with swelling of the lids and ophthalmoplegia. The disease spreads to the meninges and to the brain through the arteries, inducing thrombosis of the ophthalmic then of the internal carotid artery with subsequent hemiplegia. The prognosis is extremely poor.

The diagnosis should be made very early by biopsy of the nasal lesions, which allows identification of the causative phycomycete allowing immediate treatment.

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