A Rare Atypical Presentation of Bruns-Garland Syndrome: A Case Report and Review of Pathophysiology and Management

Abstract

Bruns-Garland Syndrome (BGS), also known as diabetic lumbosacral radiculoplexus neuropathy (DLRPN) or diabetic amyotrophy, is a rare diabetic complication causing progressive muscle weakness, neuropathic pain, and functional impairment. It primarily affects individuals with long-standing type II diabetes, with an underlying mechanism of microvasculitis-induced ischemic injury to the lumbosacral plexus, leading to axonal loss and neurogenic atrophy. We present the case of a 73-year-old physician with type II diabetes who developed progressive thigh weakness and sensory deficits over seven years. Neurological examination revealed amyotrophy, paresis in the pelvic girdle muscles, and absent deep tendon reflexes. Electroneuromyography (ENMG) demonstrated chronic neuro-radiculopathy with significant axonal loss, and MRI showed bilateral muscle atrophy, edema, and fatty replacement. Unlike typical BGS cases, which present acutely with unilateral symptoms, this patient exhibited a chronic, bilaterally progressive form, highlighting diagnostic challenges. Differential diagnoses included chronic inflammatory demyelinating polyradiculoneuropathy, lumbar spinal stenosis, and neoplastic neuropathies. Management focused on glycemic control, physical therapy, and neuropathic pain management, with consideration of immunomodulatory therapy in severe cases. This case underscores the need for heightened clinical awareness of atypical BGS presentations and the role of electrodiagnostic and imaging studies in distinguishing it from other neuropathies. Early recognition and comprehensive management are crucial to improving outcomes and preventing further functional decline.

Keywords: bruns-garland syndrome; diabetic amyotrophy; diabetic lumbosacral radiculoplexus neuropathy (dlrpn); diabetic neuropathy; electroneuromyography (enmg); lumbosacral plexopathy; microvasculitis-induced neuropathy; neurogenic muscle atrophy; peripheral nerve dysfunction; proximal diabetic neuropathy.

Figure 1. Pelvic MRI findings demonstrating bilateral paravertebral muscle atrophy with edema and partial fatty replacement (A-B: coronal STIR and T1 sequences, arrows). Bilateral gluteal muscle atrophy, more pronounced on the left, with edema and partial fatty replacement (C-F: coronal STIR and T1 sequences).