Diabetic Mononeuropathyの1例

抄録

A case of maturity-onset diabetes with right femoral mononeuropathy was reported. The patient was a 64 year old male who had suffered from diabetes mellitus for 6 years and poorly controlled. Severe pain developed suddenly on the inner side of the right thigh after walking of fairly long distance. The pain occurred intermittently thereafter and became more severe, associated with hyperesthesia during absence of pain. Also he noticed weakness of the right hip and knee areas.
On examination, the significant abnormality was confined to the neuromuscular status in the right leg. There was moderate weakness and atrophy of the right thigh muscle. Right knee jerk diminished moderately and ankle jerk was absent. There was hyperesthesia on the inner side of the right leg but no diminution of vibratory sensation in the right foot. Roentogenological study of the lumbar spine revealed slight spondylosis deformans. Las-gue's sign was not demonstrated. Fundoscopic examination showed considerable microaneurysms.
Lumbar puncture was performed and results of C. S. F. examinations were normal except for a spinal fluid protein of 75 mg and sugar of 96 mg per 100 ml. Electromyogram revealed reduced pattern. Conduction velocity of the right femoral nerve was 20.0 m/sec to show a remarkable slowing Biopsy of the right thigh muscle revealed a marked denervation atrophy.The patient obtained a good control of blood sugar by receiving glibenclamide 2.5 mg daily. But attacks of the severe pain of the right leg were not subsided by almost all of analgetics and daily dose of 0.2 g of diphenylhydantoin. However, the severe pain, especially nocturnal pain was dramatically reduced by increased daily dose of diphenylhydantoin up to 0.3 g.