Thursday, May 3, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – May 3,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Pieter AM Schreuder, Maastricht, the Netherlands



Dear colleagues,



In his LML message of April 22, 2018, Eric Slim stated that "Nerve enlargement can also be seen in diabetes related neuropathy but structural differences between diabetes and leprosy nerve impairment can be seen on ultrasound".  He also writes when Salvatore Noto questioned him about this statement: "that I was referring to the work of dr Dellon, who's surgical treatment consists of decompression of the nerve, based on the hypothesis of increased water content in the nerve resulting in subperineurial and endoneurial edema. An example for this hypothesis is papilopathy of the eye, occuring in diabetes, also caused by axonal edema."


Differential diagnosis of enlarged peripheral nerve (by Michael Donaghy Department of Clinical Neurology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK. Practical Neurology, 2003, 3, 40–45):
- Leprosy,
- Hereditary motor and sensory neuropathy,
- Neurofibromatosis,
- Refsum's disease,
- Perineuroma/localized hypertrophic neuropathy,
- Nerve tumours
- Amyloidosis

Diabetes is not mentioned.


When asking Wim Theuvenet about Eric"s statement, he writes: "I agree with Dr. Eric Slim that also in diabetes the nerves are often found to be enlarged, this in 30 to 60 % of the cases and depending on the screening technique used. This is the basis for the nerve decompressions described in the Ph.D. thesis (Utrecht March 6, 2007 Surgical approach to lower extremity nerve decompression in the patient with diabetic neuropathy) of Prof Lee Dellon. In general, the swelling is more diffuse and less tender than in leprosy. Indeed the D.D. on the basis of nerve enlargement can be difficult!


In the first place they do not refer to (peripheral nerves of) the hand/arm. In the second place they do not mention hardening of the nerves. In the third place are these edematous nerves palpable enlarged or only as seen by ultrasound? In the fourth place are the lateral popliteal and sural nerves involved in diabetes?


Very interesting topic indeed. Welcome to the discussion.



Pieter AM Schreuder



LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<

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