Diabetic Thoracic Radiculoneuropathy

Radical

Step 1: View clinicals

A 57 year old man presents with persistent burning pain and altered sensation in the right chest and abdomen for 3 months. During the same time period, he also experienced weakness of the right lower limb, and bulging out of the right abdomen after large meals. He was diagnosed with diabetes 3 years ago, but defaulted on treatment. He is not on any drugs currently, including over the counter medications and herbal remedies. His surgical and family histories are unremarkable. There is no history of contact with tuberculosis. A complete blood count, ESR, CRP, biochemical profile and toxicology screen are normal. His HbA1c level is 8.9%


Step 2: Order all relevant investigations

Ultrasound Abdomen

The ultrasound scan of the abdomen is completely normal.

Contrast MRI Spine

The contrast MRI of the cervical, dorsal, and lumbosacral spine only reveals mild cervical canal stenosis at the C3 to C6 levels.

Lumbar Puncture

Appearance: clear WBC: 2/mm3 (0 - 5) Protein: 59 mg/dL (18-58) Glucose: 200 mg/dL Gram stain and culture: Negative

Electrodiagnostic Studies

Nerve conduction velocity studies (NCV) show reduced right femoral compound muscle action potential (CMAP) amplitudes. Concomitant paraspinal electromyography (EMG) reveals denervation potentials in the thoracic and lumbar segments.


Step 3: Select appropriate management

Gabapentin
Carbamazepine
Tramadol
Muscle Strengthening Exercises


Score: ★★☆