Review of One Hundred Cases of “Diabetic Neuropathy” Followed from One to Ten Years23

Abstract

THE PRESENT review is presented because this study demonstrated that the socalled diabetic neuritis or neuropathy is not, as is still generally believed, exclusively a peripheral neuritis, but it is also a generalized neurologic disturbance involving the entire nervous system, the central, peripheral and autonomic parts, with special predilection for the peripheral nerves. There is strong evidence to suggest that the neuropathy is only one manifestation of a vitamin B deficiency in diabetic patients, and that the deficiency in most cases is secondary to the metabolic disturbances in diabetes. We found (table 1) that among the 54 cases that presented a neuritis, only 31 cases had a peripheral neuritis; 26 patients had myelopathy; nine had signs of encephalopathy alone or combined with a myelopathy and 11 cases had a neurogenic bladder without tabes. Pain and sensory disorders were the most common symptoms and signs (table 2). Muscular weakness was quite frequent, while muscular atrophy was observed in only 11 cases. Tendon reflex changes were found in only 66 cases. In most of these cases the knee and ankle jerks were either diminished or absent, usually bilaterally. The upper jerks were affected in only one case. Hyperreflexia was seen in five cases. Sphincter disorders, especially of the urinary bladder, were present in 25 cases. Seventeen patients had some gait disorder.