Diabetic Neuropathy: Pitfalls in Diagnosis

The entity of diabetic neuropathy has been recognized for many years. With increasing experience and recognition of this complication of diabetes, a broader appreciation of its clinical manifestations has taken place. Unfortunately, however, a basic confusion in diagnosis still exists. This results from the fact that the neurological syndromes are so numerous that almost any condition may be simulated. Nervous system involvement is frequently diffuse and disseminated and may present a bizarre picture. Further, the etiology, pathology, and treatment remain essentially unknown. The symptoms may indicate involvement of the peripheral nerves, the spinal roots, the spinal cord, the cerebrum, or any combination thereof.The most frequent clinical picture is characterized by involvement of the nerves of the lower extremities, most often bilaterally symmetrical and predominantly sensory.1 However, unilateral involvement may be present2; there may or may not be pain3; there may be severe pain, with a minimum