Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Severe sensory-motor axonal neuropathy following diabetic ketoacidosis

Yuichi Hamada, M.D.1), Kazusa Takahashi, M.D.1), Keiichi Hokkoku, M.D., Ph.D.1), Takamichi Kanbayashi, M.D., Ph.D.1), Yuki Hatanaka, M.D., Ph.D.1), Shunsuke Kobayashi, M.D., Ph.D.1) and Masahiro Sonoo, M.D., Ph.D.1)

1) Department of Neurology, Teikyo University School of Medicine

We report a case of severe sensory-motor axonal neuropathy on the lower extremities associated with diabetic ketoacidosis (DKA). A sixteen-year-old boy developed coma and admitted to our hospital. We diagnosed him with DKA based on remarkable hyperglycemia, severe acidosis with hyperketonemia. Intensive glycemic control with insulin was immediately started. He had complications of heart failure, rhabdomyolysis, and renal failure, which required intensive care including mechanical ventilation and hemodialysis. When recovered from the critical condition, he noticed severe weakness, numbness, and pain on the lower limbs, and urinary retention. On nerve conduction studies, both motor and sensory action potentials were absent. Serum anti-ganglioside antibodies were negative. Albuminocytologic dissociation was evident in the cerebrospinal fluid. MRI study revealed marked gadolinium enhancement of the cauda equina. After high-dose intravenous immunoglobulin treatment, he was relieved from leg pain, but the leg weakness and bladder bowel dysfunction did not show immediate improvement. It took approximately six months until he became able to stand and walk using ankle orthosis. Acute neuropathy is a rare complication of diabetes mellitus. Painful neuropathy is known to emerge in association with diabetic treatment, but it seldom causes severe motor disturbance. On the other hand, motor-dominant polyneuropathy has been reported to occur acutely along the treatment of DKA and hyperosmolar hyperglycemia syndrome (HHS). Present case and previous cases with DKA and HHS suggest that rapid correction of glucose level is one of the underlying factors of acute neuropathy related with diabetic treatment.
Full Text of this Article in PDF (1045K)

(CLINICA NEUROL, 60: 614|619, 2020)
key words: diabetic ketoacidosis, diabetic neuropathy, treatment-induced neuropathy of diabetes, diabetic neuropathic cachexia, hypoglycemic neuropathy

(Received: 13-Feb-20)