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Diabetic Amyotrophy — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularDiabetic AmyotrophySCE Neurology

A 50-year-old woman with type 2 diabetes presents with severe right thigh pain followed by quadriceps weakness and wasting over 2 weeks. She has an absent right knee jerk with otherwise normal reflexes. NCS show femoral nerve motor conduction abnormality. EMG shows denervation in the right quadriceps and iliopsoas. What is the most likely diagnosis?

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Correct answer: B — Diabetic amyotrophy (diabetic lumbosacral radiculoplexus neuropathy)

Diabetic amyotrophy (diabetic lumbosacral radiculoplexus neuropathy) presents with acute or subacute onset of severe unilateral thigh pain followed by proximal leg weakness and wasting, typically in patients with type 2 diabetes. It is caused by microvasculitis of the lumbosacral plexus and nerve roots. EMG shows denervation in L2–L4 myotomes (including iliopsoas, which rules out isolated femoral neuropathy). It is often self-limiting but recovery may take months. A: Disc prolapse at L3/4 would cause dermatomal sensory loss and radicular pain. C: Isolated femoral neuropathy would not affect iliopsoas. D: Meralgia paraesthetica is purely sensory (lateral femoral cutaneous nerve). E: Polymyositis causes symmetric proximal weakness without pain or denervation.

Reference: EAN Diabetic Neuropathy Guidelines; ABN Peripheral Neuropathy Guidelines