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Diabetic lumbosacral radiculoplexus neuropathy — SCE Neurology MCQ

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HardNeuromuscularDiabetic lumbosacral radiculoplexus neuropathySCE Neurology

A 27-year-old man presented with painful asymmetric thigh weakness with weight loss in diabetes. On examination, there was quadriceps wasting and reduced knee jerk. Initial investigations showed: EMG showed active denervation in femoral and obturator distributions. What is the most likely diagnosis?

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Correct answer: E — Diabetic lumbosacral radiculoplexus neuropathy

Diabetic lumbosacral radiculoplexus neuropathy is the best answer because the vignette describes Diabetic lumbosacral radiculoplexus neuropathy: painful diabetic amyotrophy affects lumbosacral plexus roots. Oculopharyngeal muscular dystrophy is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Motor neurone disease and Myasthenia gravis are less appropriate because they would require different localisation, timing or test findings; Statin-associated necrotising autoimmune myopathy would fit a different syndrome. Clinical pearl: lumbar canal stenosis is usually posture-related and imaging-led.

Reference: NICE NG42; ABN myasthenia gravis guidance; EAN/PNS GBS-CIDP guidance