Permanent damage of the sciatic nerve in an 8-year-old girl with newly diagnosed type 1 diabetes

ABSTRACT

Neuropathy, a complication of type 1 diabetes (T1D), is a heterogeneous group, and chronic polyneuropathy is the most common form in adults. Αn 8-year-old girl admitted with severe diabetic ketoacidosis was diagnosed with T1D. She was managed with intravenous fluids and insulin and was subsequently commenced on multiple daily subcutaneous injections of insulin. On the 7th day of hospitalisation, a right foot drop with sensory loss on the dorsal surface and cellulitis were detected and the latter responded to intravenous antibiotics. Electrophysiology demonstrated reduced nerve conduction velocity indicative of severe axonal damage of the sciatic nerve (SN). Physiotherapy along with vitamins B₆ and B₁₂ and magnesium were prescribed. Twelve months later there was no sign of clinical improvement and the selective damage of the SN was deemed to be permanent. Peripheral neuropathy can occur in children with newly diagnosed T1D.

Abbreviations: DKA: diabetic ketoacidosis; DN: diabetic neuropathy; HbA1c: glycated haemoglobin; MRC: Medical Research Council; MRI: magnetic resonance imaging; PICU: paediatric intensive care unit; SN: sciatic nerve; T1D: type 1 diabetes

KEYWORDS:

• Acute mononeuropathy
• sciatic nerve
• type 1 diabetes
• children
• ketoacidosis

Contributors’ Statement Page

S. Giza, E. Litou, E. P. Kotanidou, A. N. Kleisarchaki, P. Koliatos, T. Tzirtzipis and V. R. Tsinopoulou collected and interpreted the data and drafted and reviewed the initial manuscript. A. Tychalas performed the electrophysiological study, analysed and interpreted the data and reviewed and critically revised the manuscript. A. Evangeliou performed the neurological work-up, analysed and interpreted the data and reviewed the manuscript. A. Galli-Tsinopoulou undertook the clinical work-up, conceptualised and designed the study, coordinated and supervised the data collection, drafted the initial manuscript and reviewed and revised the manuscript. All authors approved the final manuscript and agree to be accountable for all aspects of the work.

Additional information

Notes on contributors

Styliani Giza

Styliani Giza is a paediatric consultant in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Eleni Litou

Eleni Litou is a paediatric resident and clinical fellow in paediatric endocrinology in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Eleni P. Kotanidou

Eleni P. Kotanidou is a paediatric resident in paediatrics and a postdoctoral clinical fellow in paediatric endocrinology in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Angeliki N. Kleisarchaki

Angeliki N. Kleisarchaki is clinical fellow in paediatric diabetes in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Panagiotis Koliatos

Panagiotis Koliatos is a paediatric resident in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Tasos Tzirtzipis

Tasos Tzirtzipis is a paediatric resident in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Vasiliki Rengina Tsinopoulou

Vasiliki Rengina Tsinopoulou is a research fellow in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Athanasios Tychalas

Athanasios Tychalas is a consultant in the Neurology Department, Papageorgiou General Hospital, Thessaloniki, Greece.

Athanasios Evangeliou

Athanasios Evangeliou is Professor of Paediatric Neurology in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Assimina Galli-Tsinopoulou

Assimina Galli-Tsinopoulou is Professor of Paediatric Endocrinology in the 4th Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.