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Fiber loss is primary and multifocal in sural nerves in diabetic polyneuropathy
Author(s) -
Dyck Peter James,
Lais Alfred,
Karnes Jeannine L.,
O'Brien Peter,
Rizza Robert
Publication year - 1986
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410190503
Subject(s) - polyneuropathy , medicine , sural nerve , pathological , diabetes mellitus , remyelination , diabetic neuropathy , nerve fiber , pathogenesis , ischemia , abnormality , pathology , cardiology , anatomy , endocrinology , central nervous system , myelin , psychiatry
Pathological, morphometric, and teased fiber sutides of sural nerve from 36 diabetic patients with (n = 32) and without (n = 4) neuropathy and from 47 healthy subjects provide evidence that in diabetic polyneuropathy: (1) fiber loss is primary; (2) demyelination and remyelination with or without onion bulb formation are secondary; (3) remaining fibers, on average, have the same ratio of small to large fibers as in healthy individuals, but with a greatly increased variability; and (4) the spatial distribution of fiber loss is both diffuse and multifocal. Criteria developed during the study of experimental modles of ischemic neuropathy were exployed to assess whether ischemic nerve damage had occured in diabetic polyneuropathy. We conclude that there is increasing evidence that microvascular pathological abnormality and ischemia may be involved in the pathogenesis of human diabetic polyneuropathy. Cases with selective loss of small or large afferent fibers are probably extremes of a normal distribution and not different disorders.