Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1977 Nov;40(11):1072–1082. doi: 10.1136/jnnp.40.11.1072

Nerve biopsy and conduction studies in diabetic neuropathy.

F Behse, F Buchthal, F Carlsen
PMCID: PMC492905  PMID: 599355

Abstract

Morphological findings in sural nerves were related to nerve conduction in 12 patients with diabetic neuropathy, five with mainly sensory involvement, four with severe, symmetrical sensory-motor polyneuropathy, and three with multiple mononeuropathy. All had loss of large and small myelinated and of unmyelinated fibres, even early in the disease; segmental remyelination was the most prominent myelin alteration in teased fibres, segmental demyelination was found in only a few fibres. Axonal degeneration and Schwann cell damage seem to proceed independently of each other. The relation between recorded conduction velocity and that expected from the diameter of the largest fibres indicated that slowing of 20 to 30% was due to causes other than fibre loss; a grossly diminished conduction velocity was caused mainly by fibre loss. Electrophysiological findings in the sural nerve were largely representative of findings in other nerves, though abnormalities were less marked in the median nerve. In half the endoneurial vessels from diabetic neuropathy the perivascular space was thickened or contained more layers of basal laminae than normal. The same abnormalities were found in one-quarter of the endoneurial vessels from other acquired neuropathies.

Full text

PDF
1072

Images in this article

1077Image
on p.1077
1079Image
on p.1079

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arné L., Vital C., Vallat J. M., Yung A., Leblanc M., Martin F. Neuropathie périphérique diabétique. Etude anatomo-clinique avec ultrastructure d'une biopsie nerveuse. Rev Neurol (Paris) 1972 Feb;126(2):115–126. [PubMed] [Google Scholar]
  2. BISCHOFF A. DIE DIABETISCHE NEUROPATHIE. Praxis. 1965 Jun 17;54:723–729. [PubMed] [Google Scholar]
  3. Ballin R. H., Thomas P. K. Changes at the nodes of ranvier during wallerian degeneration: an electron microscope study. Acta Neuropathol. 1969;14(3):237–249. doi: 10.1007/BF00685303. [DOI] [PubMed] [Google Scholar]
  4. Ballin R. H., Thomas P. K. Hypertrophic changes in diabetic neuropathy. Acta Neuropathol. 1968 Sep 2;11(2):93–102. doi: 10.1007/BF00690213. [DOI] [PubMed] [Google Scholar]
  5. Behse F., Buchthal F., Carlsen F., Knappeis G. G. Endoneurial space and its constituents in the sural nerve of patients with neuropathy. Brain. 1974 Dec;97(4):773–784. doi: 10.1093/brain/97.1.773. [DOI] [PubMed] [Google Scholar]
  6. Behse F., Buchthal F., Carlsen F., Knappeis G. G. Hereditary neuropathy with liability to pressure palsies. Electrophysiological and histopathological aspects. Brain. 1972;95(4):777–794. doi: 10.1093/brain/95.4.777. [DOI] [PubMed] [Google Scholar]
  7. Behse F., Buchthal F., Carlsen F., Knappeis G. G. Unmyelinated fibres and Schwann cells of sural nerve in neuropathy. Brain. 1975 Sep;98(3):493–510. doi: 10.1093/brain/98.3.493. [DOI] [PubMed] [Google Scholar]
  8. Behse F., Buchthal F. Normal sensory conduction in the nerves of the leg in man. J Neurol Neurosurg Psychiatry. 1971 Aug;34(4):404–414. doi: 10.1136/jnnp.34.4.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Behse F., Buchthal F. Peroneal muscular atrophy (PMA) and related disorders. II. Histological findings in sural nerves. Brain. 1977 Mar;100(Pt 1):67–85. doi: 10.1093/brain/100.1.67. [DOI] [PubMed] [Google Scholar]
  10. Bischoff A. Diabetische Neuropathie. PathologischeAnatomie, Pathophysiologie und Pathogenese auf Grund elektronenmikroskopischer Untersuchungen. Dtsch Med Wochenschr. 1968 Feb 9;93(6):237–passim. doi: 10.1055/s-0028-1105047. [DOI] [PubMed] [Google Scholar]
  11. Brown M. J., Martin J. R., Asbury A. K. Painful diabetic neuropathy. A morphometric study. Arch Neurol. 1976 Mar;33(3):164–171. doi: 10.1001/archneur.1976.00500030020004. [DOI] [PubMed] [Google Scholar]
  12. Chopra J. S., Hurwitz L. J., Montgomery D. A. The pathogenesis of sural nerve changes in diabetes mellitus. Brain. 1969;92(2):391–418. doi: 10.1093/brain/92.2.391. [DOI] [PubMed] [Google Scholar]
  13. Chopra J. S., Hurwitz L. J. Sural nerve myelinated fibre density and size in diabetics. J Neurol Neurosurg Psychiatry. 1969 Apr;32(2):149–154. doi: 10.1136/jnnp.32.2.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Dyck P. J., Johnson W. J., Lambert E. H., O'Brien P. C. Segmental demyelination secondary to axonal degeneration in uremic neuropathy. Mayo Clin Proc. 1971 Jun;46(6):400–431. [PubMed] [Google Scholar]
  15. GILLIATT R. W., WILLISON R. G. Peripheral nerve conduction in diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1962 Feb;25:11–18. doi: 10.1136/jnnp.25.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. GREENBAUM D., RICHARDSON P. C., SALMON M. V., URICH H. PATHOLOGICAL OBSERVATIONS ON SIX CASES OF DIABETIC NEUROPATHY. Brain. 1964 Jun;87:201–214. doi: 10.1093/brain/87.2.201. [DOI] [PubMed] [Google Scholar]
  17. Garcin R., Lapresle J. La micro-angiopathie du nerf périphérique au cours du diabète sucré. Etude ultrastructurale de biopsies nerveuses et musculaires prélevées dans trois cas de neuropathie diabétique. Bull Mem Soc Med Hop Paris. 1967 Feb 23;119(4):363–381. [PubMed] [Google Scholar]
  18. Holländer H., Vaaland J. L. A reliable staining method for semi-thin sections in experimental neurfanatomy. Brain Res. 1968 Aug 26;10(2):120–126. doi: 10.1016/0006-8993(68)90117-0. [DOI] [PubMed] [Google Scholar]
  19. Lamontagne A., Buchthal F. Electrophysiological studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1970 Aug;33(4):442–452. doi: 10.1136/jnnp.33.4.442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. REYNOLDS E. S. The use of lead citrate at high pH as an electron-opaque stain in electron microscopy. J Cell Biol. 1963 Apr;17:208–212. doi: 10.1083/jcb.17.1.208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Sharma A. K., Thomas P. K. Peripheral nerve structure and function in experimental diabetes. J Neurol Sci. 1974 Sep;23(1):1–15. doi: 10.1016/0022-510x(74)90136-1. [DOI] [PubMed] [Google Scholar]
  22. THOMAS P. K., LASCELLES R. G. SCHWANN-CELL ABNORMALITIES IN DIABETIC NEUROPATHY. Lancet. 1965 Jun 26;1(7400):1355–1357. doi: 10.1016/s0140-6736(65)92154-9. [DOI] [PubMed] [Google Scholar]
  23. Vital C., Vallat J. M., Le Blanc M., Martin F., Coquet M. Les neuropathies periphériques du diabète sucré. Etude ultrastructurale de 12-cas biopsies. J Neurol Sci. 1973 Apr;18(4):381–398. doi: 10.1016/0022-510x(73)90133-0. [DOI] [PubMed] [Google Scholar]
  24. Vizoso A. D., Young J. Z. Internode length and fibre diameter in developing and regenerating nerves. J Anat. 1948 Apr;82(Pt 1-2):110–134.1. [PMC free article] [PubMed] [Google Scholar]
  25. Williams I. R., Mayer R. F. Subacute proximal diabetic neuropathy. Neurology. 1976 Feb;26(2):108–116. doi: 10.1212/wnl.26.2.108. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES