Question: Dad approximately 3 months tried to get up and simply couldn’t. Dad has always been an independent man with no mobility problems. We took Dad to the hospital who thought Dad had had a TIA. After assessment TIA was ruled out.

Dads main symptoms were severe pain in left thigh and leg and when he tried to stand up his legs would just collapse underneath him. Dad does have some numbness in his leg. This all started in his left leg but has now developed to the right leg (right leg is now much worse than the left with exactly the same symptoms, numbness, pain and legs collapse underneath him. Numbness in left leg has now resolved but still has it in his right leg. Dads feet are always stone cold and he says he cant tell himself without touch whether both feet are hot or cold. Dad has no upper limb symptoms.

At the moment Dad can’t get from a sitting to standing position yet his left leg now has full power and can leg raise with full range of movement. The right leg however he can hardly lift it up, Dads left leg was like this at first but now the leg seems to be resolving though Dad can still not walk or stand.

We have had a follow up appointment with the Stroke Team who have now discharged Dad as they say his condition is not stroke related.

We have seen a Neurologist and are awaiting EMG studies plus MRI scan and Occupational Therapy input. Neurologist gave us no hope what so ever and said there is no treatment and reversing what is wrong with Dad. I am sure medicine these days there must be something.



Please find below the letter we got from the Neurologist:



Diagnosis: likely diabetic motor sensory neuropathy



Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had Diabetes since 2000. His control was previously poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics (18 months of antibiotics). He now describes a 2 month history of progressive weakness of both legs. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.



On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasciculation’s visible.



I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to exclude any more treatable condition but we need to do some further investigations to exclude anymore treatable causes. I am arranging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage.



Questions:

1. Do you have any idea what is wrong with my Dads legs?

2. How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)

3. Do you think this condition can resolve or get better?

4. If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?

5. What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?

6. Will my Dad ever walk again even with a Zimmer/Walking Stick?

7. What can we do to try and help Dad?

8. Will Dad ever be able to drive again?

9. I have heard my Dads condition can improve with time with a conservative measure what are your thoughts please?



Since all the above Dad has been admitted into hospital and he has had an MRI scan. The MRI scan has shown a spine bulging disc. Could this be my dads problem and not neuropathy at all?



Dads symptoms seem to be resolving the numbness, pain in thighs but Dad can not stand up.



We have Nerve Conduction Studies in a few days time.



Please help me I am so worried. The hospital say there is nothing to worry about and they are expecting Nerve Conduction Studies to come back okay.



Dad results are as follows:

MRI Spine

1. Severe canal narrowing at L5-S1 secondary to a central/left central disc protrusion on a background of a developmentally narrow canal.

2. Moderate L4-5 canal narrowing.

3. No other new features. No cord compression.



EMG/NCS

There is a sensory-motor axonopathy affecting his lower limbs which has non-length dependent and asymmetrical features consistent with his clinical findings. Overall, considering his clinical and electrophysiological features I feel it is likely this represents a Diabetic Lumbosacral Radiculo-Plexus Neuropathy (DLRPN)



I cannot exclude that abnormalities seen on sensory conduction studies are not pre-existent findings that could represent a pre-existent mild sensory axonal neuropathy considering her reports diabetic retinopathy

Can dads spinal problem first try to be treated with physical therapy as I think this is the first step at the moment