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Ischemic injury in diabetic and non-diabetic lumbosacral plexus neuropathy

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Transverse paraffin sections of sural nerves showing changes seen in diabetic and non-diabetic lumbosacral radiculoplexus neuropathy. Upper panel: Masson's trichrome stain, showing inflammation in the wall of an epineurial microvessel (right upper), probably fibrinoid degeneration of the perineurium (long arrow), and a region of neovascularization (arrowhead). Middle panel: Luxol fast blue-periodic acid-Schiff stain showing several fascicles surrounded by normal thickness perineurium (right middle, between the arrowheads) and 1 fascicle with extremely thick perineurium (left middle, between the arrowheads). Lower panel: Turnbull blue stain showing accumulation of hemosiderin (iron stains bright blue, arrow) deposited along the inner aspects of the perineurium. (Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve 2002;25:477-91. Reprinted with permission of John Wiley & Sons, Inc.)