The spatial distribution of fiber loss in diabetic polyneuropathy suggests ischemia

@article{Dyck1986TheSD,
  title={The spatial distribution of fiber loss in diabetic polyneuropathy suggests ischemia},
  author={P. James B. Dyck and Jeannine L. Karnes and Peter O'Brien and Haruo Okazaki and Alfred C. Lais and JaNean Engelstad},
  journal={Annals of Neurology},
  year={1986},
  volume={19}
}
Characterization and quantitation of the spatial distribution of pathological abnormalities along the length of nerves may be helpful in understanding the underlying mechanisms of diabetic polyneuropathy. To this end, by examining transverse sections of nerve roots and proximal‐to‐distal levels of lower limb nerves in 9 controls and 15 diabetic patients with polyneuropathy, we have determined the myelinated fiber (MF) number, size distribution, median diameter, and variability of density (MFs… 

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The distinct spatial distribution pattern of nerve fiber degeneration, in contrast to the ubiquitous presence of vasculitis, suggested that the ischemic zone that directly damages nerve fibers is present in the proximal-middle portion of peripheral nerve trunks in microscopic polyangiitis.

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TLDR
The universal reduction of axonal size in diabetic nerve may be accounted for by impaired supply of neurofilaments or reduced neurofilament synthesis, which may lead to distal axonal degeneration or contribute to the susceptibility of diabetic nerve to various external noxi, including ischemia and hypoglycemia.

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TLDR
Polyneuropathy has not yet yielded to specific forms of treatment but a variety of new trials addressing plausible hypotheses have been initiated, and an initiating role for nerve ischemia in the development of poly neuropathy has been proposed.

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This chapter reviews how disease of small nerve and ganglia microvessels, or microangiopathy, relates to the development of diabetic peripheral neuropathy. Microangiopathy involving vessels of the

Diabetic neuropathy.

  • S. Horowitz
  • Medicine, Biology
    Clinical orthopaedics and related research
  • 1993
TLDR
Pathologic and electrophysiologic studies indicate that the symmetrical polyneuropathy is characterized by a distally accentuated loss of myelinated and unmyelinated axons, which strongly suggest an ischemic cause involving the endoneurial microvascular circulation.

Endoneurial capillary abnormalities in mild human diabetic neuropathy.

TLDR
It was concluded that microvascular abnormalities are prominent in patients with clinically mild human diabetic neuropathy, and that these data provide further support for the role of endoneurial capillary disease in the development of this condition.
...

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