Summary
Clinical and neurophysiological studies were conducted in 47 patients with chronic obstructive airways disease and compared with 46 age-matched control subjects. Symptomatic neuropathy was reported in 13% and ankle jerks were absent in 45% of hypoxic patients. Peroneal and median nerve conduction velocities and median and sural sensory nerve amplitudes were significantly reduced in hypoxic patients (p<0.01). Six hypoxic patients underwent biopsy of the sural nerve, soleus muscle and overlying skin. Nerve glucose, sorbitol, fructose and myo-inositol concentrations were normal. Detailed light and electronrmicroscopy revealed both nerve fibre and microvascular pathology. Segmental demyelination (32%) and unmyelinated fibre degeneration were found to be prominent lesions. The sural nerve perineurium was thickened due to an increase in the number of perineurial lamellae and an increase in intraperineurial space. Basement membrane thickening was observed in capillaries of nerve, muscle and skin. Endothelial cell hyperplasia and hypertrophy were observed in nerve and muscle capillaries but not in skin capillaries. In conclusion, this study has provided neurological, neurophysiological and neuropathological evidence of a neuropathy in hypoxic patients with chronic obstructive airways disease. These findings may be of relevance to some aspects of the aetiology of human diabetic neuropathy.
Article PDF
Similar content being viewed by others
References
Ward JD (1989) Diabetic neuropathy. Diabetes. Br Med Bull 5: 111–126
Greene DA, Lattimer SA, Sima AAF (1987) Sorbitol phosphoinositides and sodium potassium ATPase in the pathogenesis of diabetic complications. N Engl J Med 316: 599–606
Dyck PJ (1989) Hypoxic neuropathy: does hypoxia play a role in diabetic neuropathy? Neurology 39: 111–118
Appenzeller O, Parks RD, MacGee J (1968) Peripheral neuropathy in chronic disease of the respiratory tract. Am J Med 44: 873–880
Kinsman RA, Yaroush RA, Fernandez E, Dirks JF, Schocket M, Fukihara J (1983) Symptoms and experiences in chronic bronchitis and emphysema. Chest 83: 755–761
Narayan M, Ferranti R (1978) Nerve conduction impairment in patients with respiratory insufficiency and severe chronic hypoxemia. Arch Phys Med Rehabil 59: 188–192
Valli G, Barbieri S, Sergi P, Fayoumi Z, Berardinelli P (1984) Evidence of motor neurone involvement in chronic respiratory insufficiency. J Neurol Neurosurg Psychiatry 47: 1117–1121
Paramelle B, Vila A, Pollak P, Muller P, Gavelle D, Reymond F, Brambilla C, Stoebner P (1986) Frequence des polyneuropathies dans les bronchopneumopathies chroniques obstructive. La Presse Medicale 12: 563–567
Faden A, Mendoza E, Flynn F (1981) Subclinical neuropathy associated with chronic obstructive pulmonary disease: possible pathophysiologic role of smoking. Arch Neurol 38: 639–642
Gherardi R, Benvenuti C, Lejonc JL, Louarn F, Perrier M, Schaeffer A, Degos JD (1985) Peripheral neuropathy in patients treated with almitrine dismesylate. Lancet I: 1247–1250
Chedru F, Nodzenski R, Durard JF (1985) Peripheral neuropathy during treatment with almitrine. Br Med J 290: 890
Newrick PG, Wilson AJ, Jakubowski J, Boulton AJM, Ward JD (1986) Sural nerve oxygen tension in diabetes. Br Med J 293: 1053–1054
Malik RA, Newrick PG, Sharma AK, Jennings A, Ah-See AK, Mayhew TM, Jakubowski J, Boulton AJM, Ward JD (1989) Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy. Diabetologia 32: 92–102
Low PA, Tuck RR, Takeuchi M (1987) Nerve microenvironment in diabetic neuropathy. In: Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D (eds) Diabetic neuropathy. Saunders, Philadelphia, pp 266–278
Masson EA, Church SE, Woodcock AA, Hanley SP, Boulton AJM (1988) Is resistance to ischaemic conduction failure induced by hypoxia? Diabetologia 31: 762–765
Boulton AJM, Hardisty CA, Betts RP, Frank CI, Worth RC, Ward JD, Duckworth T (1983) Dynamic foot pressure and other studies as diagnostic aids in diabetic neuropathy. Diabetes Care 6: 26–33
Bertelsmann FW, Heimans JJ, Weber EJM, Van der Veen EA, Schouten JA (1985) Thermal discrimination thresholds in normal subjects and in patients with diabetic neuropathy. J Neurol Neurosurg Psychiatry 48: 686–690
Dyck PJ, Karnes J, O'Brien PC (1987) Diagnosis, staging and classification of diabetic neuropathy and associations with complications. In: Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D (eds) Diabetic neuropathy. Saunders, Philadelphia, pp 36–44
Archer AG, Watkins PJ, Thomas PK, Sharma AK, Payan J (1983) The natural history of acute painful neuropathy in diabetes mellitus. J Neurol Neurosurg Psychiatry 46: 491–499
Lambourne JE, Tomlinson DR, Brown AM, Willars GB (1987) Opposite effects of diabetes and galactosaemia on adenosine triphosphate activity in rat nervous tissue. Diabetologia 30: 360–362
Sharma AK, Bajada S, Thomas PK (1980) Age changes in the tibial and plantar nerves of the rat. J Anat 130: 417–428
Hale PJ, Nattrass M, Silverman SH, Sennit C, Perkins CM, Uden A, Sundkvist G (1987) Peripheral nerve concentrations of glucose, fructose, sorbitol and myo-inositol in diabetic and nondiabetic patients. Diabetologia 30: 464–467
Dyck PJ, Sherman WR, Hallcher LM, Service JF, O'Brien P, Grisa LS, Palumbo PJ, Swanson CJ (1980) Human diabetic endoneurial sorbitol, fructose and myo-inositol related to sural nerve morphometry. Ann Neurol 8: 590–596
Thomas PK, Olsson Y (1984) Microscopic anatomy and function of the connective tissue components of peripheral nerve. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds), Peripheral neuropathy. Saunders, Philadelphia, pp 97–120
Low PA, Schmelzer JD, Ward KK, Yao JK (1986) Experimental chronic hypoxic neuropathy — relevance to diabetic neuropathy. Am J Physiol 280: E94-E99
Malik RA, Ah-See AK, Newrick PG (1988) Nerve fibre and microvascular abnormalities in non-neuropathic, asymptomatic diabetic patients. Diabetes 37: 480 Abstract
Behse F, Bucthal F, Carlsen F (1977) Nerve biopsy and conduction studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry 40: 1072–1079
Sugimura K, Dyck PJ (1981) Sural nerve myelin thickness and axon cylinder caliber in human diabetes. Neurology 31: 1087–1092
Dyck PJ, Hansen S, Karnes J, O'Brien P, Yasuda H, Windebank A, Zimmerman B (1985) Capillary number and percentage closed in human diabetic sural nerve. Proc Natl Acad Sci USA 82: 2513–2517
Yasuda H, Dyck PJ (1987) Abnormalities of endoneurial microvessels and sural nerve pathology in diabetic neuropathy. Neurology 37: 20–28
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Malik, R.A., Masson, E.A., Sharma, A.K. et al. Hypoxic neuropathy: relevance to human diabetic neuropathy. Diabetologia 33, 311–318 (1990). https://doi.org/10.1007/BF00403326
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00403326