Pathological changes in the central and peripheral nervous system of young long-term diabetics : I. Diabetic encephalopathy.

A study of the clinical observations and the neuropathological findings in the brain of 16 juvenile diabetics dying of diabetic angiopathy after many years of diabetes is presented. A characteristic histological pattern was observed in all the cases consisting of diffuse degenerative abnormalities of the brain tissue, often with severe pseudocalcinosis or with atrophy of the dentate nucleus, demyelinisation of the cranial nerves, fibrosis of the leptomeninges and angiopathy. The degenerative changes were so pronounced that a dual pathogenesis seems likely; viz. an ischemia caused by the angiopathy and a primary diabetic abnormality of the brain tissue. The clinical symptoms of cerebral disease varied from insignificant to pronounced. A correlation was found between the symptoms and the number of areas of softening in the brain. The histological pattern differs from that seen in other clinical conditions and justifies the term diabetic encephalopathy.