1 Copyright © 2014 Elsevier Inc. All rights reserved. Chapter 19 Diabetes and the Nervous System Douglas W. Zochodne and Cory Toth

2 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 19-1 Illustration of progressive “stocking and glove” sensory changes in a patient with progressive diabetic polyneuropathy. Sensory symptoms and signs begin in the distal territories of sensory nerves in the toes before fingers with a gradual spread proximally. (From Zochodne DW, Kline G, Smith EE, et al: Diabetic Neurology. Informa Healthcare, New York, 2010, with permission.)

3 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 19-2 Examples of nerve conduction abnormalities in a patient with moderately severe diabetic polyneuropathy (DPN) compared with waveforms in a normal subject. Note the decreased amplitude and prolonged latency of compound muscle action potentials and sensory nerve action potentials (the sural sensory nerve action potential is absent). Lines indicate nerve stimulation sites (recording site for the median motor nerve is the abductor pollicis brevis; for the median sensory nerve, the index finger; for the fibular (peroneal) motor nerve, the extensor digitorum brevis; and for the sural nerve, behind the lateral ankle). (From Zochodne DW, Kline G, Smith EE, et al: Diabetic Neurology. Informa Healthcare, New York, 2010, with permission.)

4 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 19-3 Magnetic resonance imaging (MRI) of the brain from a 62-year-old woman with type 2 diabetes mellitus for 12 years, who presented with mild ataxia of gait and polyneuropathy. These axial T2-weighted fluid- attenuated inversion recovery (FLAIR) sequences progress from caudal to rostral cuts (A to D) and show nonenhancing bilateral white matter hyperintensities (arrows in A), also termed diabetic leukoencephalopathy.