To describe the autonomic symptoms and findings from a large cohort of diabetic and non-diabetic lumbosacral radiculoplexus neuropathy ( DLRPN and non-DLRPN) cases.

Diabetic (DLRPN) and non-diabetic (non-DLRPN) lumbosacral radiculoplexus neuropathy are conditions of pain, numbness, weakness primarily involving the lower limbs and are associated with weight loss. Autonomic symptoms, findings and formal autonomic testing have been described in small numbers of DLRPN and non-DLRPN cases.

DLRPN and non-DLRPN cases were identified through a retrospective chart review.  Included cases had to have a lower limb predominant neuropathy characterized by pain, numbness or weakness with involvement on EMG of segments from at least 2 peripheral nerves and at least 2 nerve root levels.  Structural causes were excluded. All included cases had to have undergone an autonomic reflex screen.

Three hundred cases of DPRPN and one hundred cases of non-DLRPN were identified.  The cases were similar with presentations of pain, numbness and weakness and prominent autonomic abnormality. Autonomic dysfunction was present in 50% of cases for both DLRPN and non-DLRPN. When involved, composite autonomic severity score (CASS) scores ranged between 2 to 9 with a mean of 5.6 for DLRPN and between 1 to 9 with a mean of 4.1 for non-DLRPN. Means of CASS subsets (postganglionic sympathetic sudomotor, cardiovagal, cardiovascular adrenergic) were (1.9, 1.7, 1.9) and (1.5, 1.5, 1.3) for DLRPN and non-DLRPN, respectively.

Autonomic abnormalities are very common in both DLRPN and non-DLRPN. The high rates of autonomic abnormalities in the non-diabetic form means that the likely underlying mechanism for the autonomic neuropathy is not the diabetes mellitus but the inflammatory neuropathy.