Small vessel disease in progressive diabetic neuropathy associated with good metabolic control

Clinical, electrophysiological, and electron microscopical data are presented on 10 diabetic patients with severe progressive neuropathy, predominantly motor in type, in the presence of good blood glucose control, and for one patient with painful neuropathy and third cranial nerve palsy. Endothelial...

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Bibliographic Details
Published in:Journal of clinical pathology 1985-09, Vol.38 (9), p.1030-1038
Main Authors: Timperley, W R, Boulton, A J, Davies-Jones, G A, Jarratt, J A, Ward, J D
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Blood Vessels - ultrastructure
Diabetes. Impaired glucose tolerance
Diabetic Neuropathies - metabolism
Diabetic Neuropathies - pathology
Diabetic Neuropathies - physiopathology
Electromyography
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Endothelium - pathology
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Humans
Hyperplasia - pathology
Medical sciences
Microscopy, Electron
Middle Aged
Muscle Denervation
Neural Conduction
Spinal Nerves - blood supply
Sural Nerve - blood supply
Sural Nerve - ultrastructure
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Summary:Clinical, electrophysiological, and electron microscopical data are presented on 10 diabetic patients with severe progressive neuropathy, predominantly motor in type, in the presence of good blood glucose control, and for one patient with painful neuropathy and third cranial nerve palsy. Endothelial cell hyperplasia was seen in small vessels in all cases, and seven patients showed plugging of the vascular lumen by degenerate cellular material and electron dense protein. It is suggested that these cells desquamate and occlude smaller peripheral vessels at a point of narrowing. In one case the lumen of a vessel was occluded by thrombus. Electron microscopical examination showed a vessel occluded by degranulated platelets. Electrophysiological studies showed a pattern of denervation that was asymmetrical and distally predominant in some patients, suggesting that the neuropathy, at least in part, relates to multiple small infarcts.
ISSN:0021-9746
1472-4146
DOI:10.1136/jcp.38.9.1030