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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Weakness And Muscular Atrophy In The Legs When Diagnosed With Diabetes?

74 year old male, in general good health. Recently diagnosed, approx 5 months ago, with Type II diabetes but has probably had it for a long time. Recent onset of leg weakness, legs just give out at the hips, leading to falls. Significant muscle atrophy of quads and hamstrings as well as hip flexor. More atrophy in thighs than calves. Also has moderate neuropathy in thighs. Normal CT scan of hips. What are differential diagnosis? Possible ALS? Myasthenia Gravis? MS?
posted on Wed, 9 Aug 2017
Twitter Tue, 7 Nov 2017 Answered on
Twitter Wed, 8 Nov 2017 Last reviewed on
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Anesthesiologist,  's  Response
hi sir,certainly its not myasthenia as there is no diurnal fluctuation in the weakness and the pattern of involvement as mentioned in the symptamatology.In ALS,sensory system is never involved and the muscle weakness is mostly asymmetrical.please mention whether patient's neuropathy is sensory or motor.above mentioned symptoms fit into the diagnosis of DIABETIC AMYOTROPHY OR LUMBOSACRAL PLEXOPATHY.It is self limiting and resolves in 12-24 months but with good glycemic control that is HbA1c < 7% ideally 6.5%. As he is elderly plasma cell dyscrasias needs to be ruled out.
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What Causes Weakness And Muscular Atrophy In The Legs When Diagnosed With Diabetes?

hi sir,certainly its not myasthenia as there is no diurnal fluctuation in the weakness and the pattern of involvement as mentioned in the symptamatology.In ALS,sensory system is never involved and the muscle weakness is mostly asymmetrical.please mention whether patient s neuropathy is sensory or motor.above mentioned symptoms fit into the diagnosis of DIABETIC AMYOTROPHY OR LUMBOSACRAL PLEXOPATHY.It is self limiting and resolves in 12-24 months but with good glycemic control that is HbA1c 7% ideally 6.5%. As he is elderly plasma cell dyscrasias needs to be ruled out.