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Bruns-Garland syndrome: case report

RESUMO

CASE PRESENTATION: Female patient, 72 years old, hypertensive, dyslipidemic, obese, diabetic, seeks care for pain that started in the left ankle, 20 days of evolution, with burning, shock and paresthesia, with ascending progression and that reached the lumbar spine on the fifth day of evolution. . She developed paresis in the entire left lower limb, initially with leg extension, but culminating in an inability to flex, abduct, and adduct the thigh, grade 2 leg strength, and grade 1 thigh strength. Bilateral hyporeflexia. Initial suspicion of spondylosis neuropathy neurosurgery. Lumbosacral spine CT showing circumferential disc bulges between L3-L4 and L4-L5, with epidural fat effacement and determining impressions on the ventral surface of the thecal sac, with narrowing of the conjugation foramina in L4-L5 and possible involvement of the L4 roots. Cervicothoracic myelotomography without obstruction to contrast passage. Absence of spinal cord or radicular conflicts on MRI of the lumbar and thoracic spine. She evolved to partial improvement and, on the seventh day of hospitalization, she had grade 3 thigh strength and neuropathic pain relieved with gabapentin and nortriptyline. The neurology team was called, which found recent involuntary weight loss. Report of improved median mononeuropathy. Head CT without changes. Lumbar puncture with 113 proteins, 100 nucleated cells (100% lymphocytes), normal glucose, no pathogens. Electroneuromyography: left lumbar radiculoplexoneuropathy, marked recent axonal sensory-motor involvement and active signs of denervation. Glycated hemoglobin 8.5% (poor glycemic control). Effective insulin therapy was introduced. Discharged after 21 days, complete resolution of pain, walking with support.
DISCUSSION: Diabetic amyotrophy has an annual incidence of 4.2/100,000 and affects 1% of diabetics. Called Bruns-Garland Syndrome or proximal diabetic neuropathy, it is installed, probably, due to an ischemic lesion caused by microvasculitis. It appears as acute pain, proximal or distal, asymmetric and focal, followed by weakness in the proximal lower limb, autonomic dysfunction and weight loss.
FINAL COMMENTS: No treatment is proven to be effective. Data on immunosuppressive therapies are limited and controversial.

Palavras Chave

Bruns-Garland syndrome, Diabetic amyotrophy