A Rare Atypical Presentation of Bruns-Garland Syndrome: A Case Report and Review of Pathophysiology and Management

TL;DR

This paper presents a rare case of Bruns-Garland Syndrome with unusual bilateral and chronic progression, emphasizing the importance of early diagnosis and management.

Contribution

The novelty lies in highlighting an atypical presentation of Bruns-Garland Syndrome with chronic bilateral progression, expanding diagnostic awareness.

Findings

The patient exhibited a chronic, bilaterally progressive form of Bruns-Garland Syndrome, differing from typical acute unilateral presentations.

Diagnostic challenges were noted, requiring electrodiagnostic and imaging studies to distinguish from other neuropathies.

Management included glycemic control, physical therapy, and neuropathic pain management, with potential use of immunomodulatory therapy.

Abstract

Bruns-Garland Syndrome (BGS), also known as diabetic lumbosacral radiculoplexus neuropathy (DLRPN) or diabetic amyotrophy, is a rare diabetic complication causing progressive muscle weakness, neuropathic pain, and functional impairment. It primarily affects individuals with long-standing type II diabetes, with an underlying mechanism of microvasculitis-induced ischemic injury to the lumbosacral plexus, leading to axonal loss and neurogenic atrophy. We present the case of a 73-year-old physician with type II diabetes who developed progressive thigh weakness and sensory deficits over seven years. Neurological examination revealed amyotrophy, paresis in the pelvic girdle muscles, and absent deep tendon reflexes. Electroneuromyography (ENMG) demonstrated chronic neuro-radiculopathy with significant axonal loss, and MRI showed bilateral muscle atrophy, edema, and fatty replacement. Unlike typical BGS cases, which present acutely with unilateral symptoms, this patient exhibited a chronic, bilaterally progressive form, highlighting diagnostic challenges. Differential diagnoses included chronic inflammatory demyelinating polyradiculoneuropathy, lumbar spinal stenosis, and neoplastic neuropathies. Management focused on glycemic control, physical therapy, and neuropathic pain management, with consideration of immunomodulatory therapy in severe cases. This case underscores the need for heightened clinical awareness of atypical BGS presentations and the role of electrodiagnostic and imaging studies in distinguishing it from other neuropathies. Early recognition and comprehensive management are crucial to improving outcomes and preventing further functional decline.

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