VA Morning Report Pearls: Neurologic Potpourri!!

Today we have a Pearl Potpourri of Neurologic Diagnoses to keep in mind:

  1. Diabetic Amyotrophy AKA Proximal Diabetic Neuropathy AKA Bruns-Garland syndrome – is a rare diagnosis in the category of diseases called lumbosacral plexopathies that are all generally rare and that have various causes. Of note, technically, Diabetic amyotrophy is not a true plexopathy because it also affects peripheral nerves. The prevailing thought is that this condition is caused by microvascular injury to the nerves leading to ischemia which results in the symptoms of first, proximal leg pain and, then, weakness which progresses over weeks to months. Often, symptoms will start in one leg, and soon after will spread to affect the other leg. Some patients will recover completely while others will only have a partial improvement in their symptoms. Most patients who develop this are middle aged and have DM type II. In one case series of patients with this condition, the patients mostly did not have other end-organ sequelae of diabetes and for many it was their presenting symptom of diabetes! (Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Dyck et al. Neurology. 1999;53(9);2113)
  2. Numb Chin Syndrome – is facial numbness in the mental nerve distribution of the 5th cranial nerve. Most cases of numb chin syndrome, understandably, stem from dental conditions but the second most common cause of this rare condition is malignancy! In a series of 12 cases of NCS related to malignancy, the condition was the first sign of malignancy in 7/12 cases (esp breast ca) and it was a sign of relapse after therapy in 5/12. Keep this diagnosis in mind when a patient notes sensory complaints on the face! (Chin Numbness: A Symptom That Should Not be Underestimated: A Review of 12 Cases. Colella, G et al. Amer Journal of the Medical Sciences.2009;337(6);407)
  3. Non-convulsive Status Epilepticus – is a condition of prolonged abnormal electrical activity in the brain without convulsions that occurs in patients with chronic epilepsy but also in patients who are critically ill. It can be easily missed if we aren’t vigilant, especially in the ICU. Indeed, one series found that 19% of critically ill patients who underwent continuous EEG monitoring for evaluation of AMS (in this case unexplained decreased level of consciousness/coma) where having seizures, 92% of which were non-convulsive. How aggressively to treat these patients with anti-epileptic agents is an area of debate among neurologists so phone a neurological friend if you suspect it and don’t forget to look at your med list for possible causative drugs (many abx, etc.) (Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Claassen J et al. Neurology. 2004;62(10);1743)
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