SUMMARY

Diabetic neuropathy is currently the most common neuropathy in the world, and it is associated with a wide range of clinical manifestations. The vast majority of patients with clinical diabetic neuropathy have a distal symmetrical form of the disorder that progresses following a fiberlength-dependent pattern, with sensory and autonomic manifestations predominating. Occasionally, patients with diabetes can develop focal and multifocal neuropathies that include cranial nerve involvement and limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, and mostly in patients with long-standing diabetes mellitus. Length-dependent diabetic polyneuropathy does not show any trend towards improvement, and either relentlessly progresses or remains relatively stable over a number of years. Conversely, the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self-limited, sometimes after a relapsing course. Other causes of neuropathies must be excluded in diabetic patients with focal neuropathies, and treatable causes must always be sought in diabetic patients with disabling motor deficit.

Key Words: Proximal diabetic neuropathy; diabetic ophthalmoplegia; thoracic neuropathy; inflammatory diabetic neuropathy; nerve biopsy.

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