لخّصلي

Clinical picture:

• In early diabetes or in the pre-diabetic stage, the neuropathy is of the mononeuritic type which may affect the sciatic, femoral, lateral popliteal, ulnar, or median nerves or CN 3, 6 or 7.Silent myocardial infarction.- The polyneuropathy is mainly sensory with pain, paranesthesia, or superficial sensory loss specially in the LL beginning in the toes then gradual progression to involve the legs and can progress to affect the hands.Gastroparesis diabeticorum: indigestion and delayed gastric emptying.Trophic skin changes: ulcers, loss of hair, brittle nails, and Charcot's neuropathic joint.??????

Clinical picture:

• In early diabetes or in the pre-diabetic stage, the neuropathy is of the
  mononeuritic type which may affect the sciatic, femoral, lateral popliteal,
  ulnar, or median nerves or CN 3, 6 or 7.


• In frank diabetes, the neuropathy is of the polyneuritic type.


• The polyneuropathy is mainly sensory with pain, paranesthesia, or superficial
  sensory loss specially in the LL beginning in the toes then gradual progression
  to involve the legs and can progress to affect the hands. Again, beginning in
  the fingers and move proximally to result finally in stock and glove
  hypoesthesia.


• The deep sensations are also lost, resulting in loss of deep reflexes and
  sensory ataxia. The muscle sense is increased at first resulting in tender calf
  followed later by lost muscle sense.


• Motor weakness may occur late in the disease.


• Autonomic manifestations:
  ▪ Impotence and lost testicular sensation.
  ▪ Sensory, motor, or autonomic bladder.
  ▪ Postural hypotension resting tachycardia.
  ▪ Silent myocardial infarction.
  ▪ Gastroparesis diabeticorum: indigestion and delayed gastric emptying.
  ▪ Hyperhydrosis or anhydrosis.
  ▪ Trophic skin changes: ulcers, loss of hair, brittle nails, and Charcot's
  neuropathic joint.