Spinal meningeoma in the differential diagnosis of diabetic polyneuropathy

History and admission findings: A 70 year old woman had suffered from diabe tes mellitus type 2 since she was 52. Three years before the surgery she ha d begun to experience weakness together with altered sensitivity in the rig ht leg,which was regarded as having been caused by diabetic polyneuropathy. During the admission examination the level for algesia on the right-hand s ide was at about D11, a distal paraparesis of the leg (3-4 degrees, Janda's classification), more intense on the right, hyperactive deep tendon reflex es, Babinski's reflex on both sides, and depressed abdominal cutaneous refl exes. The sensitivity to vibrations on the Malleolus medialis on both sides was 0/8. The patient could walk only with the help of a Rollator. Investigations: Over the three-year period following onset of symptoms the following tests were carried out: motor nerve conduction speeds of the N. t ibialis and N. peronaeus, electromyogram of the N. tibialis anterior and th e M. gastrocnemius, somatosensory evoked potentials (SSEP) of the N. tibial is, which indicated a lesion in the peripheral nerves or nerve roots. Crani al computed tomography (CCT), CT scan of the lumbar spine (L3-S1) and angio logical investigation elicited no significant pathological findings. An MRI of the thoracal spine showed a vertebra-sized dorsal tumor pressing on the spinal cord from left to right. Treatment and course: By means of microsurgery the spinal tumor was complet ely removed. Suspected meningeoma was confirmed by histological analysis. D uring the post-surgical period, the incomplete paraplegia quickly regressed , and 7 weeks after the removal of the spinal meningeoma the patient was ab le to climb stairs. Conclusion: In case of slowly-developing paresis of the legs in diabetic pa tients, diabetic polyneuropathy should not be diagnosed without careful con sideration, and rare spinal tumors should be considered as part of the diff erential diagnosis, especially if the blood glucose level is normal, and in tensive physiotherapy brings no improvement in the patient's condition.