A 60-Year-Old Man with Long-Standing Type 2 Diabetes Mellitus Comes

question 828

Multiple Choice

A 60-year-old man with long-standing type 2 diabetes mellitus comes to the physician due to progressive weakness.  Six months ago he started experiencing tingling and numbness in his feet.  A few weeks later he experienced similar symptoms in his hands.  Over the last 2 months he has been having increasing difficulty rising from a chair, going up stairs, and lifting objects.  He does not have slurred speech, difficulty breathing, changes in vision, bowel or bladder dysfunction, or back pain.
His neurological examination reveals symmetric, proximal and distal, and upper and lower extremity muscle weakness associated with atrophy.  He has reduced vibration, proprioception, and pinprick sensation that is worse in the legs compared to his arms.  His reflexes are diminished in the upper extremities and absent in the lower extremities.  Plantar responses are flexor bilaterally.
Which of the following is the most likely diagnosis?

• A)Amyotrophic lateral sclerosis
• B)Chronic inflammatory demyelinating polyradiculoneuropathy
• C)Diabetic polyneuropathy
• D)Guillain-Barré syndrome
• E)Lambert-Eaton myasthenic syndrome

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