myelopathy due to diabetes
Introduction
Introduction to diabetes-induced myelopathy Diabetes complications are more common, and neurological complications are more common in patients with severe diabetes or long-term disease and poor disease control. The incidence of diabetes-induced myelopathy is not high in its complications, and the spinal cord disease caused by diabetes is also called diabetic spinal cord syndrome. Diabetes is caused by a decrease in islet function in the human body, a disorder caused by absolute or relative lack of insulin secretion, and a metabolic disorder such as fat and protein. At present, the study believes that metabolic disorders are the root cause of various complications, including the following aspects: 1 glucose metabolism disorder, sorbitol deposition, inositol reduction is the most serious damage to nerve cells. 2 microvascular disease, diabetic atherosclerosis stenosis of the vascular lumen, microcirculatory disorders. 3 secondary changes in blood components after diabetes, such as elevated plasma fibrinogen, increased platelet activation, increased adhesion of platelets to the blood vessel wall, increased opportunities for aggregation between platelets can cause ischemic infarction. basic knowledge The proportion of illness: 0.0015% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Causes of myelopathy caused by diabetes
Metabolic disorders (25%):
Current research suggests that metabolic disorders are the root cause of various complications, including the following:
1 glucose metabolism disorder, with sorbitol deposition, inositol reduction is the most serious damage to nerve cells.
2 microvascular disease, diabetic atherosclerosis stenosis of the vascular lumen, microcirculatory disorders.
3 secondary changes in blood components after diabetes, such as elevated plasma fibrinogen, increased platelet activation, increased adhesion of platelets to the blood vessel wall, increased opportunities for aggregation between platelets can cause ischemic infarction.
High blood sugar (25%):
Hyperglycemia can increase the activity of aldose reductase in peripheral nerve cell cells (Schwann cells), accelerate the process of glucose conversion to sorbitol, and sorbitol can be oxidized to produce fructose by sorbitol dehydrogenase to make Yamanashi Alcohol and fructose accumulate excessively in the cells, causing an increase in intracellular osmotic pressure and retention of sodium and water. As a result, Schwann cells are degenerated, myelin loss and axonal degeneration, involving the posterior root and posterior cord of the spinal cord, and the clinical manifestations resemble the spinal cord. Hemorrhoids, the occurrence of spinal cord softening, is mainly related to arteriosclerosis caused by diabetes.
Some patients have positive antiphospholipid antibodies, indicating that the pathogenesis of diabetic myelopathy is also related to autoimmunity.
Diabetes is not effectively controlled (30%):
The underlying cause is that diabetes is not effectively controlled, leading to spinal cord lesions.
Prevention
Diabetes-induced prevention of myelopathy
Mainly to prevent and treat diabetes, the primary prevention focus is reasonable diet, moderate exercise, control of blood sugar, and prevention of complications.
Complication
Diabetes-induced complications of myelopathy Complication
Diabetes has more complications and can exist at the same time. In combination with spinal cord lesions, paraplegia, urinary dysfunction and other peripheral autonomic dysfunction (no sweat, head and hand compensatory hyperhidrosis) may occur.
Symptom
Symptoms of myelopathy caused by diabetes common symptoms gait instability, sensory disturbance, muscle atrophy, spinal cord lesions, reflexes, reflexes, reflexes
1. Diabetic ataxia is mainly caused by posterior root and posterior cord injury, knee reflexes disappear, deep sensation includes positional sensation and shock sensation, patient gait is unstable, bladder tension is reduced, and sometimes lower limb lightning-like pain occurs. .
2. Diabetic muscular atrophy is more common in elderly patients, manifested as progressive muscle atrophy, and the proximal limb muscle atrophy is more severe than the distal end, asymmetrical or one side with pelvic belt, quadriceps-based muscle Pain, weakness and atrophy, a few can be combined with scapular sling, upper arm muscle atrophy, pathological findings of spinal cord anterior horn cells disappeared, mostly caused by retrograde damage caused by anterior root and motor nerve damage.
3. Diabetic spinal cord softening of spinal cord softening, mainly related to arteriosclerosis caused by diabetes, it causes occlusion of spinal cord blood vessels, ischemia, severe cases cause a small amount of bleeding, if the anterior vertebral artery occlusion causes the artery in the ventral side of the spinal cord 2/3 The supply area has extensive softening, clinical manifestations of paraplegia, sensory loss plane and sphincter dysfunction, etc., because the posterior spinal cord is supplied by the posterior lingual artery, the collateral circulation of the posterior spinal artery is abundant, so it can be normal without damage. The position and vibration.
4. Diabetic amyotrophic lateral sclerosis syndrome is more common in adults with a longer history of diabetes. It is characterized by distal muscle atrophy of the upper extremities, which can be symmetrically distributed. There is obvious systemic "meat jumping" and hyperreflexia. The disease progresses very slowly. The course of disease lasts for 10 years, but the muscle atrophy is still relatively light. Therefore, unlike the amyotrophic lateral sclerosis in the degenerative disease, the EMG shows that the H reflex disappears and the peroneal nerve sensory conduction velocity is prolonged.
Examine
Examination of diabetes-induced myelopathy
1. Determination of blood sugar and glucose tolerance.
2. Other blood tests include liver function, kidney function, routine examination of erythrocyte sedimentation rate; rheumatism series, immunoglobulin electrophoresis and other serological tests related to autoimmunity.
3. Cerebrospinal fluid examination.
4. Electromyography and neurophysiological examination.
5. Spinal MRI examination.
Diagnosis
Diagnosis and diagnosis of diabetic myelopathy
The diagnosis of this disease, first of all should be determined to have the presence of diabetes, as well as the presence of spinal cord lesions: upper and lower motor neuron damage symptoms, sensory impairment symptoms, autonomic neurological symptoms can occur.
In the nervous system diseases, it should be differentiated from syphilitic spinal cord sputum, subacute combined degeneration, progressive spinal atrophy and anterior cerebral artery syndrome. Because of the presence of diabetes, it is generally difficult to rule out.
