Brain, Vol 120, Issue 7 1131-1138, Copyright © 1997 by Oxford University Press
M Theriault, J Dort, G Sutherland and DW Zochodne
Microangiopathy is considered relevant to the pathogenesis of several forms
of peripheral nerve disease, particularly diabetic polyneuropathy. In
diabetes, however, it is uncertain whether reductions in mixed nerve trunk
blood flow account for early features of polyneuropathy in contrast to
later disease, where microvascular changes have been described. To address
this issue, we measured local sural nerve blood flow in patients with mild
diabetic polyneuropathy who were enrolled in a clinical trial (n = 26),
patients with other polyneuropathies being studied by diagnostic sural
nerve biopsy (n = 17), patients with vasculitic polyneuropathy (n = 3) and
one patient with rapidly progressive severe diabetic polyneuropathy and
lumbosacral plexopathies. Standardized measurements were made at 10 sites
along the sural nerve of each patient prior to sural nerve resection for
biopsy. We used a laser Doppler flowmetry probe sensitive to red blood cell
flux to measure sural nerve blood flow. This was slightly higher in
patients with mild diabetes compared with those with other
polyneuropathies, but was reduced in patients with vasculitis. In patients
with mild diabetes, there was no relationship between sural nerve blood
flow and prebiopsy sural nerve action-potential amplitude, sural myelinated
fibre density, haemoglobin A1C, duration of diabetes or age of the patient.
Ten diabetic patients entered in the clinical trial had sural nerve blood
flow recorded in one sural nerve, followed 1 year later by a second sural
nerve blood flow measurement prior to biopsy of the contralateral sural
nerve. Despite a mild trend toward decline in fibre density between the
nerves over this period of time, sural nerve blood flow was similar. The
patient with severe diabetic polyneuropathy and lumbosacral plexopathies
had reduced sural nerve blood flow. Our findings do not provide evidence
that reductions in sural nerve blood flow are associated with early
peripheral neuropathy in diabetes, unlike vasculitis. The early trend
toward slight rises in sural nerve blood flow may be a result of early
functional microangiopathy that accompanies nerve dysfunction but does not
cause it.
ARTICLES
Local human sural nerve blood flow in diabetic and other polyneuropathies
Neurosciences Research Group, University of Calgary, Alberta, Canada.
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