1
|
Miller TA, Ross DC. Sciatic and tibial neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:165-181. [PMID: 38697738 DOI: 10.1016/b978-0-323-90108-6.00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The sciatic nerve is the body's largest peripheral nerve. Along with their two terminal divisions (tibial and fibular), their anatomic location makes them particularly vulnerable to trauma and iatrogenic injuries. A thorough understanding of the functional anatomy is required to adequately localize lesions in this lengthy neural pathway. Proximal disorders of the nerve can be challenging to precisely localize among a range of possibilities including lumbosacral pathology, radiculopathy, or piriformis syndrome. A correct diagnosis is based upon a thorough history and physical examination, which will then appropriately direct adjunctive investigations such as imaging and electrodiagnostic testing. Disorders of the sciatic nerve and its terminal branches are disabling for patients, and expert assessment by rehabilitation professionals is important in limiting their impact. Applying techniques established in the upper extremity, surgical reconstruction of lower extremity nerve dysfunction is rapidly improving and evolving. These new techniques, such as nerve transfers, require electrodiagnostic assessment of both the injured nerve(s) as well as healthy, potential donor nerves as part of a complete neurophysiological examination.
Collapse
Affiliation(s)
- Thomas A Miller
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Health Care, Parkwood Institute, London, ON, Canada.
| | - Douglas C Ross
- Division of Plastic Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Health Care, Roth McFarlane Hand and Upper Limb Centre, London, ON, Canada
| |
Collapse
|
2
|
Pirola R, Visser LH, Nasr-Eldin YK, Krzesniak-Swinarska M, Wheat SW, Cartwright MS. Neuromuscular ultrasound in leprosy: A scanning protocol. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1529-1535. [PMID: 37860974 DOI: 10.1002/jcu.23591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
The diagnosis of leprosy neuropathies has been traditionally based on clinical findings and electrodiagnostic studies, but ultrasound has emerged as a new tool for use in clinical practice. We conducted a literature search on the subject and developed a pragmatic ultrasound scanning protocol for patients with confirmed or suspected leprosy neuropathy. We suggest scanning the ulnar, median, superficial radial, common fibular and sural nerves at specific sites and assessing cross-sectional area, vascularity, and epineural thickness. Our protocol is potentially useful in differentiating leprosy neuropathies from other demyelinating neuropathies, but its applicability and accuracy must be evaluated in different centers.
Collapse
Affiliation(s)
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, ETZ Hospital, Tilburg, The Netherlands
| | - Yasmin K Nasr-Eldin
- Rheumatology and Rehabilitation Department, Minia University, Al Minya, Egypt
| | | | - Stephen Wilkes Wheat
- Department of Neurology-Guest Lecturer, Baylor College of Medicine, Houston, Texas, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
3
|
Collins MP, Hadden RDM, Shahnoor N. Primary perineuritis, a rare but treatable neuropathy: Review of perineurial anatomy, clinicopathological features, and differential diagnosis. Muscle Nerve 2023; 68:696-713. [PMID: 37602939 DOI: 10.1002/mus.27949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
The perineurium surrounds each fascicle in peripheral nerves, forming part of the blood-nerve barrier. We describe its normal anatomy and function. "Perineuritis" refers to both a nonspecific histopathological finding and more specific clinicopathological entity, primary perineuritis (PP). Patients with PP are often assumed to have nonsystemic vasculitic neuropathy until nerve biopsy is performed. We systematically reviewed the literature on PP and developed a differential diagnosis for histopathologically defined perineuritis. We searched PubMed, Embase, Scopus, and Web of Science for "perineuritis." We identified 20 cases (11 M/9F) of PP: progressive, unexplained neuropathy with biopsy showing perineuritis without vasculitis or other known predisposing condition. Patients ranged in age from 18 to 75 (mean 53.7) y and had symptoms 2-24 (median 4.5) mo before diagnosis. Neuropathy was usually sensory-motor (15/20), painful (18/19), multifocal (16/20), and distal-predominant (16/17) with legs more affected than arms. Truncal numbness occurred in 6/17; 10/18 had elevated cerebrospinal fluid (CSF) protein. Electromyography (EMG) and nerve conduction studies (NCS) demonstrated primarily axonal changes. Nerve biopsies showed T-cell-predominant inflammation, widening, and fibrosis of perineurium; infiltrates in epineurium in 10/20 and endoneurium in 7/20; and non-uniform axonal degeneration. Six had epithelioid cells. 19/20 received corticosteroids, 8 with additional immunomodulators; 18/19 improved. Two patients did not respond to intravenous immunoglobulin (IVIg). At final follow-up, 13/16 patients had mild and 2/16 moderate disability; 1/16 died. Secondary causes of perineuritis include leprosy, vasculitis, neurosarcoidosis, neuroborreliosis, neurolymphomatosis, toxic oil syndrome, eosinophilia-myalgia syndrome, and rarer conditions. PP appears to be an immune-mediated, corticosteroid-responsive disorder. It mimics nonsystemic vasculitic neuropathy. Cases with epithelioid cells might represent peripheral nervous system (PNS)-restricted forms of sarcoidosis.
Collapse
Affiliation(s)
- Michael P Collins
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Nazima Shahnoor
- Neuromuscular Pathology Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
4
|
Cotti Piccinelli S, Tagliapietra M, Cavallaro T, Labella B, Risi B, Caria F, Damioli S, Poli L, Padovani A, Ferrari S, Filosto M. Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study. Biomedicines 2023; 11:2468. [PMID: 37760909 PMCID: PMC10525615 DOI: 10.3390/biomedicines11092468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
The extent of nerve involvement in leprosy is highly variable in distribution and clinical presentation. Mononeuropathies, multiple mononeuropathies, and polyneuropathies can present both in the context of a cutaneous and/or systemic picture and in the form of pure neuritic leprosy (PNL). The differential diagnosis of leprosy neuropathy remains challenging because it is a very rare condition and, especially in Western countries, is often overlooked. We report one case of the polyneuropathic form of PNL (P-PNL) and one case of multiple mononeuropathy in paucibacillary leprosy. In both cases, the diagnosis was achieved by performing a sural nerve biopsy, which showed subverted structure, severe infiltration of inflammatory cells in nerve fascicles, granulomatous abnormalities, and the presence of alcohol-acid-resistant, Ziehl-Neelsen-positive bacilli inside the nerve bundles. Leprosy remains an endemic disease in many areas of the world, and globalization has led to the spread of cases in previously disease-free countries. In this perspective, our report emphasizes that the diagnostic possibility of leprosy neuropathy should always be taken into account, even in Western countries, in the differential diagnostic process of an acquired sensory polyneuropathy or multineuropathy and confirms that nerve biopsy remains a useful procedure in working up neuropathies with unknown etiology.
Collapse
Affiliation(s)
- Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Matteo Tagliapietra
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, Italy; (M.T.); (T.C.); (S.F.)
| | - Tiziana Cavallaro
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, Italy; (M.T.); (T.C.); (S.F.)
| | - Beatrice Labella
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Barbara Risi
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, Italy; (M.T.); (T.C.); (S.F.)
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| |
Collapse
|
5
|
Cohen JC, de Souza Muniz AM, Carvalho Junior RB, de Oliveira HLC, Miranda ST, Gomes MK, da Cunha AJLA, Menegaldo LL. Gait analysis of leprosy patients with foot drop using principal component analysis. Clin Biomech (Bristol, Avon) 2023; 105:105983. [PMID: 37167843 DOI: 10.1016/j.clinbiomech.2023.105983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Peripheral nerve injury caused by leprosy can lead to foot drop, resulting in an altered gait pattern that has not been previously described using 3D gait analysis. METHODS Gait kinematics and dynamics were analyzed in 12 patients with unilateral foot drop caused by leprosy and in 15 healthy controls. Biomechanical data from patients' affected and unaffected limbs were compared with controls using inferential statistics and a standard distance, based on principal components analysis (PCA). FINDINGS Patients walked slower than controls (0.8 ± 0.2 vs. 1.1 ± 0.2 m/s, p = 0.003), with a reduced stance and increased swing percentage. The affected limb increased (p < 0.05) plantar flexion at the initial contact (-16.8o ± 8.3), terminal stance (-29.1o ± 11.5), and swing (-12.4o ± 6.2) in the affected limb compared to unaffected (-6.6o ± 10.3; -14.6o ± 11.6; 2.4o ± 7.6) and controls (-5.4o ± 2.5; -18.8o ± 5.8; -1.4o ± 3.9). Increased pelvic tilt and knee adduction/abduction range, with lower hip adduction, were observed. The second peak of ground reaction force (98.6 ± 5.2 %BW), ankle torque (0.99 ± 0.33 Nm/kg), and net ankle work in stance (-0.03 ± 5.4 J/Kg) decreased in the affected limb compared to controls (104.1 ± 5.5 %BW; 1.24 ± 0.4 Nm/kg; -4.58 ± 5.19 J/kg; p < 0.05). There were decreasing multivariate standard distances in the affected limb compared with the unaffected and controls. PCA loading factors highlighted the major differences between groups. INTERPRETATION Leprosy patients with foot drop presented altered gait patterns in affected and unaffected limbs. There were remarkable differences in ankle kinematics and dynamics. Rehabilitation devices, such as ankle foot orthosis or tendon transfer surgeries to increase ankle dorsiflexion, could benefit these patients and reduce deviations from normal gait.
Collapse
Affiliation(s)
- Jose Carlos Cohen
- Hospital Universitário, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | - Adriane Mara de Souza Muniz
- Programa de Engenharia Biomédica (PEB/COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Escola de Educação Física do Exército (EsEFEx) - (Brazilian Army), Brazil
| | | | | | - Silvana T Miranda
- Hospital Universitário, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | - Maria Kátia Gomes
- Hospital Universitário, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | | | - Luciano L Menegaldo
- Programa de Engenharia Biomédica (PEB/COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Brazil.
| |
Collapse
|
6
|
Penna PS, Pitta IJR, Vital RT, Hacker MAVB, Salles AM, Pinheiro RO, Antunes SLG, Sarno EN, Jardim MR. Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy. Mem Inst Oswaldo Cruz 2023; 117:e220150. [PMID: 36651454 PMCID: PMC9870262 DOI: 10.1590/0074-02760220150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The lepromatous pole is a stigmatising prototype for patients with leprosy. Generally, these patients have little or no symptoms of peripheral nerve involvement at the time of their diagnosis. However, signs of advanced peripheral neuropathy would be visible during the initial neurological evaluation and could worsen during and after multidrug therapy (MDT). Disabilities caused by peripheral nerve injuries greatly affect these patients' lives, and the pathophysiological mechanisms underlying nerve damage remain unclear. OBJECTIVES To evaluate the outcome of peripheral neuropathy in patients with lepromatous leprosy (LL) and persistent neuropathic symptoms years after completing MDT. METHODS We evaluated the medical records of 14 patients with LL who underwent nerve biopsies due to worsening neuropathy at least four years after MDT. FINDINGS Neuropathic pain developed in 64.3% of the patients, and a neurological examination showed that most patients had alterations in the medium- and large-caliber fibers at the beginning of treatment. Neurological symptoms and signs deteriorated despite complete MDT and prednisone or thalidomide use for years. Nerve conduction studies showed that sensory nerves were the most affected. MAIN CONCLUSIONS Patients with LL can develop progressive peripheral neuropathy, which continues to develop even when they are on long-term anti-inflammatory and immunosuppressive therapy.
Collapse
Affiliation(s)
- Patricia Sola Penna
- Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Neurologia, Rio de Janeiro, RJ, Brasil,+ Corresponding author:
| | - Izabela Jardim Rodrigues Pitta
- Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Neurologia, Rio de Janeiro, RJ, Brasil,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil,Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | - Ana Maria Salles
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Roberta Olmo Pinheiro
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Sergio Luiz Gomes Antunes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Euzenir Nunes Sarno
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Márcia Rodrigues Jardim
- Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Neurologia, Rio de Janeiro, RJ, Brasil,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Departamento de Hanseníase, Rio de Janeiro, RJ, Brasil,Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
7
|
Somensi DN, de Sousa EDJS, Lopes GL, de Sousa GC, Xavier MB. Clinical and electrophysiological characteristics of neuropathic pain in leprosy patients: A prospective cross-sectional study. Indian J Dermatol Venereol Leprol 2021; 88:641-644. [PMID: 34951937 DOI: 10.25259/ijdvl_917_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. METHODS Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. RESULTS Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. LIMITATIONS The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. CONCLUSION The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease.
Collapse
|
8
|
Kaya D, Garnes ND, Robins A, Su SY, Ginsberg LE, Chen MM. Leprosy of the great auricular nerve: case report and review of the literature. Clin Imaging 2021; 82:63-66. [PMID: 34775253 DOI: 10.1016/j.clinimag.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/03/2022]
Abstract
We report clinical, imaging and pathology findings of a patient with leprosy of the great auricular nerve who presented with palpable nodules and numbness of the left ear and scalp. Ultrasound and contrast-enhanced CT imaging of the neck demonstrated diffuse enlargement and enhancement of the great auricular nerve. Biopsy of the enlarged left great auricular nerve revealed granulomatous inflammation with necrosis involving the nerve with rare Fite-positive organisms compatible with mycobacterium. Positive PCR for Mycobacterium leprae of the surgical specimen confirmed diagnosis of Hansen's disease.
Collapse
Affiliation(s)
- Diana Kaya
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Infection Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Natalie Dailey Garnes
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Infection Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Alison Robins
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Infection Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shirley Yu Su
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Infection Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Lawrence E Ginsberg
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Infection Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Melissa Mei Chen
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Infection Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
9
|
Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009794. [PMID: 34555035 PMCID: PMC8491942 DOI: 10.1371/journal.pntd.0009794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/05/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP. METHODOLOGY/PRINCIPAL FINDINGS This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients' hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs. CONCLUSION IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.
Collapse
|
10
|
LoRusso S. Infections of the Peripheral Nervous System. Continuum (Minneap Minn) 2021; 27:921-942. [PMID: 34623098 DOI: 10.1212/con.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes infections that affect the peripheral nervous system, including their clinical features, differential diagnoses, and treatments. RECENT FINDINGS Rates of pyomyositis have increased recently in the United States, possibly because of an increase in risk factors such as IV drug use, obesity, and diabetes. Other peripheral nervous system infections, such as diphtheria, have become more common in older patients secondary to a lack of revaccination or waning immunity. Although recommended treatment regimens for most infections remain unchanged over recent years, debate over the ideal dosing and route of administration continues for some infections such as tetanus and leprosy (Hansen disease). SUMMARY Infections of the peripheral nervous system are varied in terms of the type of infection, localization, and potential treatment. Nerve conduction studies and EMG can help determine localization, which is key to determining an initial differential diagnosis. It is important to recognize infections quickly to minimize diagnostic delays that could lead to patient morbidity and mortality.
Collapse
|
11
|
Manchanda R, Dhar N, Kumar M, Kumar N, Tiwari A. Thickened sural nerve in Hansen's disease. QJM 2021; 114:202-203. [PMID: 32614397 DOI: 10.1093/qjmed/hcaa216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Manchanda
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - N Dhar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - M Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - N Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - A Tiwari
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| |
Collapse
|
12
|
Liu K, Wang Y, Li H. The Role of Ninjurin1 and Its Impact beyond the Nervous System. Dev Neurosci 2021; 42:159-169. [PMID: 33657559 DOI: 10.1159/000512222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022] Open
Abstract
Ninjurin1 (Ninj1) is a double-transmembrane cell surface protein that could promote nerve regeneration in the process of the peripheral nervous system injury and repairment. Nonetheless, the accurate function of Ninj1 in the central nervous system and outside the nervous system is not completely clear. According to the recent studies, we found that Ninj1 is also aberrantly expressed in various pathophysiological processes in vivo, including inflammation, tumorigenesis, and vascular, bone, and muscle homeostasis. These findings suggest that Ninj1 may play an influential role during these pathophysiological processes. Our review summarizes the diverse roles of Ninj1 in multiple pathophysiological processes inside and outside the nervous system. Ninj1 should be considered as an important and novel therapeutic target in certain diseases, such as inflammatory diseases and ischemic diseases. Our study provided a better understanding of Ninj1 in different pathophysiological processes and thereby provided the theoretical support for further research.
Collapse
Affiliation(s)
- Ke Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongge Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| |
Collapse
|
13
|
Živković SA, Gruener G, Narayanaswami P. Doctor-Should I get the COVID-19 vaccine? Infection and immunization in individuals with neuromuscular disorders. Muscle Nerve 2021; 63:294-303. [PMID: 33471383 PMCID: PMC8013955 DOI: 10.1002/mus.27179] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 12/13/2022]
Abstract
The clinical course of neuromuscular disorders (NMDs) can be affected by infections, both in immunocompetent individuals, and in those with reduced immunocompetence due to immunosuppressive/immunomodulating therapies. Infections and immunizations may also trigger NMDs. There is a potential for reduced efficacy of immunizations in patients with reduced immunocompetence. The recent vaccination program for coronavirus disease-2019 (COVID-19) raises several questions regarding the safety and efficacy of this vaccine in individuals with NMDs. In this Practice Topic article, we address the role of vaccine-preventable infections in NMDs and the safety and efficacy of immunization in individuals with NMDs, with emphasis on vaccination against COVID-19.
Collapse
Affiliation(s)
- Sasha A. Živković
- Department of NeurologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Gregory Gruener
- Department of Neurology, Stritch School of MedicineLoyola UniversityChicagoIllinoisUSA
| | - Pushpa Narayanaswami
- Department of NeurologyHarvard Medical School/Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | |
Collapse
|
14
|
Dos Santos DF, Antunes DE, Dornelas BC, da Cunha BA, Oliveira TJ, Pereira RC, Goulart LR, Goulart IMB. Peripheral nerve biopsy: a tool still needed in the early diagnosis of neural leprosy? Trans R Soc Trop Med Hyg 2020; 114:792-797. [PMID: 32710545 DOI: 10.1093/trstmh/traa053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/27/2020] [Accepted: 07/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The early recognition of neural impairment in leprosy, especially in primary neural forms, represents a challenge in clinical practice and a peripheral nerve biopsy may be required for diagnostic confirmation. This study aims to characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural cases in leprosy. METHODS A total of 104 patients with peripheral neuropathy who were referred to a national reference centre for leprosy were biopsied from 2014 to 2018. All cases underwent clinical, laboratory, histopathological and electroneuromyographic evaluations. RESULTS Of 104 biopsied patients, leprosy was confirmed in 89.4% (93/104). The biopsied nerves were the ulnar (67.8% [63/93]), superficial fibular (21.5% [20/93]), sural (8.6% [8/93]), radial (1.1% [1/93]) and deep fibular (1.1% [1/93]). Twenty-nine percent (27/93) presented histopathological abnormalities and 4.4% (4/93) presented acid-fast bacilli. Nerve and superjacent skin quantitative polymerase chain reaction were positive in 49.5% (46/93) and 24.8% (23/93) of cases, respectively. Patients with multiple mononeuropathy had a higher frequency of histopathological abnormalities (p=0.0077). CONCLUSIONS This study reinforces peripheral nerve biopsy's role as an important tool in the investigation of primary neural cases, contributing to the early diagnosis and also reducing diagnostic errors and the need for empirical treatment.
Collapse
Affiliation(s)
- Diogo Fernandes Dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Bruno Carvalho Dornelas
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Bruno Araujo da Cunha
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Thales Junqueira Oliveira
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| |
Collapse
|
15
|
Abstract
Introduction: Carpal tunnel syndrome and ulnar neuropathy are such common maladies affecting the upper extremties that they often become the default diagnosis when patients complain of numbness, pain, or weakness of the hands. While often correct, there are a number of other conditions that can also cause sensory or motor loss of the hands, which should be considered when appropriate, as they can mimic upper extremity entrapment syndromes. Methods: In this review, we will discuss such mimics, including Charcot-Marie-Tooth disease, multifocal motor neuropathy, hereditary neuropathy with pressure palsies, mononeuropathy multiplex, Lewis-Sumner syndrome, brachial plexitis (Parsonage-Turner syndrome), myotonic dystrophy, inclusion body myopathy, and distal myopathy of Welander. We will discuss the clinical presentation, as well as diagnostic testing, treatment (if available), and prognosis. Conclusion: The objective is to provide a differential diagnosis for those patients who do not fit well clinically or respond to usual therapy for entrapment neuropathy of the upper extremities.
Collapse
Affiliation(s)
- James M. Gilchrist
- Southern Illinois University School of Medicine, Springfield, USA,James M. Gilchrist, Department of Neurology, Southern Illinois University School of Medicine, 751 N. Rutledge Street, PO Box 19643, Springfield, IL 62794, USA.
| | | |
Collapse
|
16
|
Mahajan NP, Lavania M, Singh I, Nashi S, Preethish-Kumar V, Vengalil S, Polavarapu K, Pradeep-Chandra-Reddy C, Keerthipriya M, Mahadevan A, Yasha TC, Nandeesh BN, Gnanakumar K, Parry GJ, Sengupta U, Nalini A. Evidence for Mycobacterium leprae Drug Resistance in a Large Cohort of Leprous Neuropathy Patients from India. Am J Trop Med Hyg 2020; 102:547-552. [PMID: 31933458 DOI: 10.4269/ajtmh.19-0390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resistance to anti-leprosy drugs is on the rise. Several studies have documented resistance to rifampicin, dapsone, and ofloxacin in patients with leprosy. We looked for point mutations within the folP1, rpoB, and gyrA gene regions of the Mycobacterium leprae genome predominantly in the neural form of leprosy. DNA samples from 77 nerve tissue samples were polymerase chain reaction (PCR)-amplified for M leprae DNA and sequenced for drug resistance-determining regions of genes rpoB, folP1, and gyrA. The mean age at presentation and onset was 38.2 ± 13.4 (range 14-71) years and 34.9 ± 12.6 years (range 10-63) years, respectively. The majority had borderline tuberculoid leprosy (53 [68.8%]). Mutations associated with resistance were identified in 6/77 (7.8%) specimens. Mutations seen were those associated with resistance to rifampicin, ofloxacin, and dapsone. All the six patients were drug-naive. The clinical and pathological manifestations in this group did not differ from the drug-sensitive group. This study highlights the occurrence of resistance to the standard multidrug therapy and ofloxacin in leprosy. Among the entire cohort, 1/77 (1.3%) showed resistance to rifampicin, 2/77 (2.6%) to dapsone, and 5/77 (6.4%) to ofloxacin. Six new patients showing infection by mutant strains indicated the emergence of primary resistance. Resistance to ofloxacin could be due to frequent use of quinolones for many bacterial infections. The results of the study indicate the need for development of a robust and strict surveillance system for detecting drug resistance in leprosy in India.
Collapse
Affiliation(s)
- Niranjan Prakash Mahajan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mallika Lavania
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Itu Singh
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Muddasu Keerthipriya
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Krishnamurthy Gnanakumar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gareth J Parry
- Department of Neurology, St John's Medical College, Bangalore, India
| | - Utpal Sengupta
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| |
Collapse
|
17
|
Shukla B, Verma R, Kumar V, Kumar M, Malhotra KP, Garg RK, Malhotra HS, Sharma PK, Kumar N, Uniyal R, Pandey S, Rizvi I. Pathological, ultrasonographic, and electrophysiological characterization of clinically diagnosed cases of pure neuritic leprosy. J Peripher Nerv Syst 2020; 25:191-203. [PMID: 32250546 DOI: 10.1111/jns.12372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Abstract
A subset of neuritic form of leprosy, called pure neuritic leprosy (PNL), seen in a minority of leprosy patients, is characterized by peripheral neuropathy without skin lesions and an absence of acid-fast bacilli on skin smears. Patients with PNL are often started on drug therapy without confirmation of diagnosis. We, therefore, did a prospective study of clinically diagnosed PNL patients with correlation of ultrasonographic and biopsy findings. A total of 100 consecutive patients with PNL, diagnosed according to the consensus case definition, were included in the study. All patients underwent nerve conduction study, peripheral nerve ultrasonography, and sural nerve biopsy. Multiple mononeuropathies were present in 75% of cases, mononeuropathy in 18%, and polyneuropathy in the remaining 7%. Compared to clinical examination, ultrasonographic assessment of the peripheral nerves was not only better at the detection of thickening but also helped in characterization of their fascicular architecture, echogenicity, and vascularity. A total of 32 cases were confirmed on nerve biopsy, out of which 75% had demonstrable lepra bacilli. Cranial nerve involvement, presence of trophic ulcers, and bilateral thickening of the great auricular nerve were significantly associated with the positivity of lepra bacilli. A significant improvement in the disability score happened after multidrug therapy. A comprehensive electrophysiologic, ultrasonographic, and histological evaluation may be helpful in establishing a diagnosis of PNL with greater confidence, while ruling out other non-leprosy diagnoses.
Collapse
Affiliation(s)
| | | | - Vijay Kumar
- Department of Plastic Surgery, KGMU, Lucknow, India
| | - Manoj Kumar
- Department of Radiology, KGMU, Lucknow, India
| | | | | | | | | | | | - Ravi Uniyal
- Department of Neurology, KGMU, Lucknow, India
| | | | - Imran Rizvi
- Department of Neurology, KGMU, Lucknow, India
| |
Collapse
|
18
|
Cell Biology of Intracellular Adaptation of Mycobacterium leprae in the Peripheral Nervous System. Microbiol Spectr 2020; 7. [PMID: 31322104 DOI: 10.1128/microbiolspec.bai-0020-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The mammalian nervous system is invaded by a number of intracellular bacterial pathogens which can establish and progress infection in susceptible individuals. Subsequent clinical manifestation is apparent with the impairment of the functional units of the nervous system, i.e., the neurons and the supporting glial cells that produce myelin sheaths around axons and provide trophic support to axons and neurons. Most of these neurotrophic bacteria display unique features, have coevolved with the functional sophistication of the nervous system cells, and have adapted remarkably to manipulate neural cell functions for their own advantage. Understanding how these bacterial pathogens establish intracellular adaptation by hijacking endogenous pathways in the nervous system, initiating myelin damage and axonal degeneration, and interfering with myelin maintenance provides new knowledge not only for developing strategies to combat neurodegenerative conditions induced by these pathogens but also for gaining novel insights into cellular and molecular pathways that regulate nervous system functions. Since the pathways hijacked by bacterial pathogens may also be associated with other neurodegenerative diseases, it is anticipated that detailing the mechanisms of bacterial manipulation of neural systems may shed light on common mechanisms, particularly of early disease events. This chapter details a classic example of neurodegeneration, that caused by Mycobacterium leprae, which primarily infects glial cells of the peripheral nervous system (Schwann cells), and how it targets and adapts intracellularly by reprogramming Schwann cells to stem cells/progenitor cells. We also discuss implications of this host cell reprogramming by leprosy bacilli as a model in a wider context.
Collapse
|
19
|
Agarwal A, Chandra A, Jaipal U, Bagarhatta M, Mendiratta K, Goyal A, Kumar R, Mangalhara N. Can imaging be the new yardstick for diagnosing peripheral neuropathy?-a comparison between high resolution ultrasound and MR neurography with an approach to diagnosis. Insights Imaging 2019; 10:104. [PMID: 31676930 PMCID: PMC6825074 DOI: 10.1186/s13244-019-0787-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Peripheral neuropathies are a group of disorders which affect the peripheral nervous system which have been conventionally diagnosed using electrodiagnostic studies. This study was carried out to assess the role of imaging in diagnosing peripheral mononeuropathy as exact anatomical localisation of the pathology is possible using high-resolution ultrasound and MR neurography, the modalities assessed in this study. METHOD A hospital-based prospective analytical study was carried out in a resource-limited setting on 180 peripheral nerves in 131 patients with symptoms of peripheral mononeuropathy after taking IRB approval. Each patient underwent high-resolution ultrasound examination and MR neurography, findings of which were then compared and statistically analysed assuming electrodiagnostic findings as the gold standard. RESULTS Overall, the diagnostic accuracy was highest for the proton density fat-saturated MR sequence (93.89%) followed by high-resolution ultrasound (80%). The sensitivity was highest for proton density fat-saturated sequence while the T1 MR sequence had the highest specificity. Combined diagnostic accuracy of both modalities was calculated to be 93.33% with a negative predictive value of 80%. High-resolution ultrasound and MRI equally detected the cases with nerve discontinuity, while neuromas were better identified on MRI. CONCLUSION With the advent of higher frequency probes and improved MR field strength, imaging of peripheral nerves is possible with better accuracy. Imaging assessment of nerves allows anatomical delineation with identification of exact site of involvement. This comparative study demonstrates the role of imaging in diagnosing peripheral nerve pathologies with the accuracy of MRI as high as 93.89% which may serve as an imaging gold standard. High-resolution ultrasound, being quicker, cost effective and a comparable accuracy of 80% can serve as a reliable screening tool. This study incorporates a larger study group and compares HRUS with MRI, taking NCV as gold standard, which has not been done in the preceding studies. With this study, we conclude that these two imaging modalities are not mutually exclusive. Rather, they complement each other and can be used in conjunction as an imaging yardstick for diagnosing peripheral neuropathies.
Collapse
Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India. .,Malviya Nagar, Jaipur, India.
| | | | - Usha Jaipal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | - Meenu Bagarhatta
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | | | - Alka Goyal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | - Raghav Kumar
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | | |
Collapse
|
20
|
Mupparapu M, Ko E, Omolehinwa TT, Chhabra A. Neurologic Disorders of the Maxillofacial Region. Dent Clin North Am 2019; 64:255-278. [PMID: 31735232 DOI: 10.1016/j.cden.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The maxillofacial region is complex in its anatomy and in its variation in the presentation of neurologic disorders. The diagnosis and management of neurologic disorders in clinical practice remains a challenge. A good understanding of the neurologic disorder in its entirety helps dentists in the diagnosis and appropriate referral to a specialist for further investigations and management of the condition. Neurologic disorders described in this article are under broad categories of sensory and motor disturbances as well as movement disorders and infections. This article summarizes the most common maxillofacial neurologic disorders that dentists might encounter in clinical practice.
Collapse
Affiliation(s)
- Mel Mupparapu
- University of Pennsylvania School of Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA.
| | - Eugene Ko
- University of Pennsylvania School of Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA
| | - Temitope T Omolehinwa
- University of Pennsylvania School of Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA
| | - Avneesh Chhabra
- UT Southwestern Medical Center, Harry Hines Boulevard, Dallas, TX 75390, USA
| |
Collapse
|
21
|
Neurosurgical treatment of leprosy neuropathy in a low-incidence, European country. Neurol Sci 2019; 40:1371-1375. [PMID: 30903414 DOI: 10.1007/s10072-019-03835-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/11/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Leprosy is nowaday increasingly encountered in non-endemic countries. Nerve involvement is common. Swelling of the nerves may lead to entrapment neuropathy causing pain and neurological deficits. Delay in diagnosis and treatment may lead to loss of chance of improvement. Surgical decompression in conjunction with medical therapy allows relief of symptoms. METHODS We present a retrospective series of 21 patients surgically treated in our center for leprosy entrapment neuropathy. We report presentation, treatment, and outcome at follow-up including a brief literature review. RESULTS Twenty-one patients were treated for nerve entrapments in four different anatomical districts. We reported good clinical outcomes mainly in motor deficits but also in improvement of sensitive deficits and pain symptoms. We did not experience surgical complications. DISCUSSION Although there is a lack of high-quality prospective studies comparing medical and surgical treatment of leprosy neuropathy, benefits of surgery are widely reported in series and case reports from endemic countries. There is scant literature from low-incidence countries even if leprosy incidence is nowaday increasing in these countries and will likelihood further increase in the future. Our results are in line with the literature presenting good outcomes after surgery. CONCLUSION We believe that a precise knowledge of the pathology and its management is crucial also for physicians who work in low-incidence countries to maximize healing chances with timely diagnosis and treatment.
Collapse
|
22
|
Agarwal A, Chandra A, Jaipal U, Saini N. Imaging in the diagnosis of ulnar nerve pathologies-a neoteric approach. Insights Imaging 2019; 10:37. [PMID: 30895491 PMCID: PMC6426899 DOI: 10.1186/s13244-019-0714-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
The ulnar nerve is a branch of the C8 and T1 nerve roots and arises from the medial cord of the brachial plexus. It supplies the intrinsic muscles of the hand and assists the median nerve in functioning of the flexors. Also known as the musician’s nerve, it is the second most common nerve involved in compressive neuropathy following the median nerve. Common sites of entrapment include cubital tunnel at the elbow, the ulnar groove in the humerus and the Guyon’s canal at the wrist. Patients present with altered sensation in the ulnar fourth and the fifth digit and the medial side of arm with loss of function of intrinsic muscles of the hand, the flexor carpi ulnaris and ulnar fibres of flexor digitorum superficialis in more severe cases. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus, or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of ulnar neuropathies as seen on ultrasound and MRI and emphasises upon the importance of imaging modalities in the diagnosis of neuropathies.
Collapse
Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India. .,, A 235, Shivanand Marg, Malviya Nagar, Jaipur, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
23
|
McCorquodale D, Smith AG. Clinical electrophysiology of axonal polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:217-240. [PMID: 31307603 DOI: 10.1016/b978-0-444-64142-7.00051-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Axonal neuropathies encompass a wide range of acquired and inherited disorders with electrophysiologic characteristics that arise from the unique neurophysiology of the axon. Accurate interpretation of nerve conduction studies and electromyography requires an in-depth understanding of the pathophysiology of the axon. Here we review the unique neurophysiologic properties of the axon and how they relate to clinical electrodiagnostic features. We review the length-dependent Wallerian or "dying-back" processes as well as the emerging body of literature from acquired axonal neuropathies that highlights the importance of axonal disease at the nodes of Ranvier. Neurophysiologic features of individual inherited and acquired axonal diseases, including primary nerve disease as well as systemic immune mediated, metabolic, and toxic diseases involving the peripheral nerve, are reviewed. This comprehensive review of electrodiagnostic findings coupled with the current understanding of pathophysiology will aid the clinician in the evaluation of axonal polyneuropathies.
Collapse
Affiliation(s)
- Donald McCorquodale
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - A Gordon Smith
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
| |
Collapse
|
24
|
Aarão TLDS, de Sousa JR, Falcão ASC, Falcão LFM, Quaresma JAS. Nerve Growth Factor and Pathogenesis of Leprosy: Review and Update. Front Immunol 2018; 9:939. [PMID: 29867937 PMCID: PMC5949531 DOI: 10.3389/fimmu.2018.00939] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/16/2018] [Indexed: 12/11/2022] Open
Abstract
Neurotrophins are a family of proteins that regulate different aspects of biological development and neural function and are of great importance in neuroplasticity. This group of proteins has multiple functions in neuronal cells, as well as in other cellular populations. Nerve growth factor (NGF) is a neurotrophin that is endogenously produced during development and maturation by multiple cell types, including neurons, Schwann cells, oligodendrocytes, lymphocytes, mast cells, macrophages, keratinocytes, and fibroblasts. These cells produce proNGF, which is transformed by proteolytic cleavage into the biologically active NGF in the endoplasmic reticulum. The present review describes the role of NGF in the pathogenesis of leprosy and its correlations with different clinical forms of the disease and with the phenomena of regeneration and neural injury observed during infection. We discuss the involvement of NGF in the induction of neural damage and the pathophysiology of pain associated with peripheral neuropathy in leprosy. We also discuss the roles of immune factors in the evolution of this pathological process. Finally, we highlight avenues of investigation for future research to broaden our understanding of the role of NGF in the pathogenesis of leprosy. Our analysis of the literature indicates that NGF plays an important role in the evolution and outcome of Mycobacterium leprae infection. The findings described here highlight an important area of investigation, as leprosy is one of the main causes of infection in the peripheral nervous system.
Collapse
Affiliation(s)
| | | | | | | | - Juarez Antônio Simões Quaresma
- Center of Health and Biological Sciences, State University of Para, Belem, Brazil.,Tropical Medicine Center, Federal University of Para, Belem, Brazil.,Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| |
Collapse
|
25
|
Tiwari V, Malhotra K, Khan K, Maurya PK, Singh AK, Thacker AK, Husain N, Kulshreshtha D. Evaluation of polymerase chain reaction in nerve biopsy specimens of patients with Hansen's disease. J Neurol Sci 2017; 380:187-190. [PMID: 28870564 DOI: 10.1016/j.jns.2017.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pure neuritic variety of leprosy (PNL) presents as peripheral neuropathy with absent skin lesions and negative skin smears. Diagnosing PNL is an uphill task as most of these patients have nonspecific changes on nerve biopsy. In such circumstances, additional molecular diagnostic tools like polymerase chain reaction (PCR) has proven to be useful in diagnosing leprosy. The present study was planned to evaluate the role of PCR in nerve biopsy specimens of patients with PNL. METHODS Patients attending the neuromuscular clinic from January 2013 to June 2014 with mononeuropathy multiplex underwent detailed diagnostic evaluation to ascertain the cause of neuropathy. Patients where this evaluation failed to establish an etiology underwent a nerve biopsy. RESULTS Nerve biopsy was done in 52 patients, of which 35 were diagnosed as pure neuritic leprosy. Definite leprosy with positive wade fite staining for lepra bacilli was seen in 13 patients and 22 biopsies revealed a probable leprosy without lepra bacilli being identified. PCR for M. leprae was positive in 22 patients (62%). 12 of the 13 cases with definite leprosy on histopathology were PCR positive while in the AFB negative group, PCR was positive in 10 cases. PCR had a sensitivity of 92.3%, specificity of 54.5%. The positive and negative predictive value of PCR was 54.5% and 92.3% respectively. CONCLUSIONS PCR helps in diagnosing PNL in doubtful cases. A positive PCR increases the sensitivity of detection of M. leprae especially in cases of probable PNL group where AFB cannot be demonstrated on histopathology.
Collapse
Affiliation(s)
- Vandana Tiwari
- Department of Biochemistry, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Kiranpreet Malhotra
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, India
| | - Kainat Khan
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, India
| | - Pradeep K Maurya
- Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Ajai Kumar Singh
- Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Anup Kumar Thacker
- Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
| |
Collapse
|
26
|
Berlit P, Hadisurya J. [Polyneuropathy - causes and treatment]. MMW Fortschr Med 2017; 159:62-68. [PMID: 28656450 DOI: 10.1007/s15006-017-9051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Peter Berlit
- Klinik für Neurologie, Alfried-Krupp-Krankenhaus Rüttenscheid, Alfried-Krupp-Straße 21, D-45131, Essen, Deutschland.
| | | |
Collapse
|
27
|
Nogueira-Barbosa MH, Lugão HB, Gregio-Júnior E, Crema MD, Kobayashi MT, Frade MA, Pavan TZ, Carneiro AA. Ultrasound elastography assessment of the median nerve in leprosy patients. Muscle Nerve 2017; 56:393-398. [DOI: 10.1002/mus.25510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 01/13/2023]
Affiliation(s)
| | - Helena B. Lugão
- Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | - Michel D. Crema
- Department of Radiology, Saint-Antoine Hospital; University Paris VI; France
| | | | - Marco A.C. Frade
- Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Theo Z. Pavan
- Physics Department, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto; University of São Paulo; Brazil
| | - Antonio A.O. Carneiro
- Physics Department, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto; University of São Paulo; Brazil
| |
Collapse
|
28
|
Lugão HB, Frade MAC, Mazzer N, Foss NT, Nogueira-Barbosa MH. Leprosy with ulnar nerve abscess: ultrasound findings in a child. Skeletal Radiol 2017; 46:137-140. [PMID: 27785545 DOI: 10.1007/s00256-016-2517-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 02/02/2023]
Abstract
We report the ultrasound findings of a typical case of nerve abscess due to leprosy in an 11-year-old boy. The patient had previously undergone pediatric multibacillary leprosy multidrug therapy (MDT) in accordance with World Health Organization guidelines. He presented to our service with bilateral ulnar neuritis with no response to prednisone (1 mg/kg). Right ulnar nerve ultrasound revealed nerve hypoechogenicity, fascicular pattern disorganization, marked fusiform thickening, and a round anechoic area suggestive of intraneural abscess. Intense intraneural power Doppler signal was detected, indicating active neuritis. Intravenous methylprednisolone had a poor response and the patient was submitted to ulnar nerve decompression, which confirmed nerve abscess with purulent discharge during surgery. As the patient weighed more than 40 kg, treatment with a pediatric dose was considered insufficient and adult-dose MDT was prescribed, with improvement of nerve pain and function. Although leprosy is rare in developed countries, it still exists in the USA and it is endemic in many developing countries. Leprosy neuropathy is responsible for the most serious complications of the disease, which can lead to irreversible impairments and deformities. Nerve abscess is an uncommon complication of leprosy and ultrasound can efficiently demonstrate this condition, allowing for prompt treatment. There is scant literature about the imaging findings of nerve abscess in leprosy patients. Radiologists should suspect leprosy in patients with no other known causes of neuropathy when detecting asymmetric nerve enlargement and nerve abscess on ultrasound.
Collapse
Affiliation(s)
- Helena Barbosa Lugão
- Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário, Av. Bandeirantes 3900, Ribeirão Preto, CEP 14049-900, São Paulo, Brazil.
| | - Marco Andrey Cipriani Frade
- Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário, Av. Bandeirantes 3900, Ribeirão Preto, CEP 14049-900, São Paulo, Brazil
| | - Nilton Mazzer
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Norma Tiraboschi Foss
- Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário, Av. Bandeirantes 3900, Ribeirão Preto, CEP 14049-900, São Paulo, Brazil
| | | |
Collapse
|
29
|
Galtrey CM, Modarres H, Jaunmuktane Z, Brandner S, Rossor AM, Lockwood DN, Reilly MM, Manji H, Schon F. Leprosy in a patient infected with HIV. Pract Neurol 2016; 17:135-139. [PMID: 27941127 DOI: 10.1136/practneurol-2016-001519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/03/2022]
Abstract
A 60-year-old Nigerian man, who had lived in Europe for 30 years but had returned home frequently, presented with right frontalis muscle weakness and right ulnar nerve palsy, without skin lesions. Neurophysiology showed a generalised neuropathy with demyelinating features. Blood tests were positive for HIV, with a normal CD4 count. There was nerve thickening both clinically and on MRI. Nerve biopsy showed chronic endoneuritis and perineuritis (indicating leprosy) without visible mycobacteria. His neuropathy continued to deteriorate (lepra reaction) before starting treatment with WHO multidrug therapy, highly active antiretroviral therapy and corticosteroids. There are 10 new cases of leprosy diagnosed annually in the UK. Coinfection with HIV is rare but paradoxically does not usually adversely affect the outcome of leprosy or change treatment. However, permanent nerve damage in leprosy is common despite optimal therapy. Leprosy should be considered in patients from endemic areas who present with mononeuritis multiplex.
Collapse
Affiliation(s)
| | | | - Zane Jaunmuktane
- Division of Neuropathology, Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Alexander M Rossor
- Department of Molecular Neurosciences, MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, UK
| | | | - Mary M Reilly
- Department of Molecular Neurosciences, MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, UK
| | - Hadi Manji
- Department of Molecular Neurosciences, MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, UK
| | - Fred Schon
- St George's University Hospitals, London, UK
| |
Collapse
|
30
|
Rana A, Thakur S, Bhardwaj N, Kumar D, Akhter Y. Excavating the surface-associated and secretory proteome of Mycobacterium leprae for identifying vaccines and diagnostic markers relevant immunodominant epitopes. Pathog Dis 2016; 74:ftw110. [PMID: 27856491 DOI: 10.1093/femspd/ftw110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/13/2016] [Accepted: 11/13/2016] [Indexed: 02/03/2023] Open
Abstract
For centuries, Mycobacterium leprae, etiological agent of leprosy, has been afflicting mankind regardless of extensive use of live-attenuated vaccines and antibiotics. Surface-associated and secretory proteins (SASPs) are attractive targets against bacteria. We have integrated biological knowledge with computational approaches and present a proteome-wide identification of SASPs. We also performed computational assignment of immunodominant epitopes as coordinates of prospective antigenic candidates in most important class of SASPs, the outer membrane proteins (OMPs). Exploiting the known protein sequence and structural characteristics shared by the SASPs from bacteria, 17 lipoproteins, 11 secretory and 19 novel OMPs (including 4 essential proteins) were identified in M. leprae As OMPs represent the most exposed antigens on the cell surface, their immunoinformatics analysis showed that the identified 19 OMPs harbor T-cell MHC class I epitopes and class II epitopes against HLA-DR alleles (54), while 15 OMPs present potential T-cell class II epitopes against HLA-DQ alleles (6) and 7 OMPs possess T-cell class II epitopes against HLA-DP alleles (5) of humans. Additionally, 11 M. leprae OMPs were found to have B-cell epitopes and these may be considered as prime candidates for the development of new immunotherapeutics against M. leprae.
Collapse
Affiliation(s)
- Aarti Rana
- School of Life Sciences, Central University of Himachal Pradesh, Shahpur, District-Kangra, Himachal Pradesh-176206, India
| | - Shweta Thakur
- School of Life Sciences, Central University of Himachal Pradesh, Shahpur, District-Kangra, Himachal Pradesh-176206, India
| | - Nupur Bhardwaj
- School of Life Sciences, Central University of Himachal Pradesh, Shahpur, District-Kangra, Himachal Pradesh-176206, India
| | - Devender Kumar
- School of Life Sciences, Central University of Himachal Pradesh, Shahpur, District-Kangra, Himachal Pradesh-176206, India
| | - Yusuf Akhter
- School of Life Sciences, Central University of Himachal Pradesh, Shahpur, District-Kangra, Himachal Pradesh-176206, India
| |
Collapse
|
31
|
Kulshreshtha D, Malhotra KP, Maurya PK, Singh AK, Thacker AK, Husain N. Nerve biopsy in Indian patients with mononeuropathy multiplex of undetermined etiology. Muscle Nerve 2016; 55:23-27. [DOI: 10.1002/mus.25179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 04/26/2016] [Accepted: 05/05/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Dinkar Kulshreshtha
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Kiran Preet Malhotra
- Department of PathologyDr Ram Manohar Lohia Institute of Medical SciencesGomtinagar, Lucknow Uttar Pradesh India
| | - Pradeep Kumar Maurya
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Ajai Kumar Singh
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Anup Kumar Thacker
- Department of Neurology Dr Ram Manohar Lohia Institute of Medical SciencesVibhuti KhandGomtinagar, Lucknow Uttar Pradesh226010 India
| | - Nuzhat Husain
- Department of PathologyDr Ram Manohar Lohia Institute of Medical SciencesGomtinagar, Lucknow Uttar Pradesh India
| |
Collapse
|
32
|
Affiliation(s)
| | | | - Hadi Manji
- National Hospital for Neurology & Neurosurgery
| |
Collapse
|
33
|
|
34
|
|
35
|
Raicher I, Baccarelli R, Marciano LH, Ura S, Virmond MC, Teixeira MJ, Ciampi de Andrade D. Neuropathic pain in leprosy. Clin Dermatol 2016; 34:59-65. [DOI: 10.1016/j.clindermatol.2015.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
36
|
Lugão HB, Nogueira-Barbosa MH, Marques Jr. W, Foss NT, Frade MAC. Asymmetric Nerve Enlargement: A Characteristic of Leprosy Neuropathy Demonstrated by Ultrasonography. PLoS Negl Trop Dis 2015; 9:e0004276. [PMID: 26646143 PMCID: PMC4672904 DOI: 10.1371/journal.pntd.0004276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Neurological involvement occurs throughout the leprosy clinical spectrum and is responsible for the most feared consequences of the disease. Ultrasonography (US) provides objective measurements of nerve thickening and asymmetry. We examined leprosy patients before beginning multi-drug therapy aiming to describe differences in US measurements between classification groups and between patients with and without reactions. Methodology/Principal Findings Eleven paucibacillary (PB) and 85 multibacillary (MB) patients underwent nerve US. Twenty-seven patients had leprosy reactions (type 1, type 2 and/or acute neuritis) prior to US. The ulnar (at the cubital tunnel–Ut–and proximal to the tunnel–Upt), median (M) and common fibular (CF) nerves were scanned to measure cross-sectional areas (CSAs) in mm2 and to calculate the asymmetry indexes ΔCSA (absolute difference between right and left CSAs) and ΔUtpt (absolute difference between Upt and Ut CSAs). MB patients showed greater (p<0.05) CSAs than PB at Ut (13.88±11.4/9.53±6.14) and M (10.41±5.4/6.36±0.84). ΔCSAs and ΔUtpt were similar between PB and MB. The CSAs, ΔCSAs and ΔUtpt were similar between PB patients with reactions compared to PB patients without reactions. MB patients with reactions showed significantly greater CSAs (Upt, Ut and M), ΔCSAs (Upt and Ut) and ΔUtpt compared to MB patients without reactions. PB and MB showed similar frequencies of abnormal US measurements. Patients with reactions had higher frequency of nerve thickening and similar frequency of asymmetry to those without reactions. Conclusions/Significance This is the first study to investigate differences in nerve involvement among leprosy classification groups using US before treatment. The magnitude of thickening was greater in MB and in patients with reactions. Asymmetry indexes were greater in patients with reactions and did not significantly differ between PB and MB, demonstrating that asymmetry is a characteristic of leprosy neuropathy regardless of its classification. Leprosy is an infectious disease that affects the peripheral nerves, leading to nerve thickening, asymmetry and dysfunction; therefore, early detection of leprosy neuropathy is important for preventing deformities and disabilities. We examined peripheral nerve involvement using ultrasonography (US) in 96 leprosy patients prior to treatment, aiming to better understand differences in neuropathy patterns between leprosy classification groups and between patients with and without leprosy reactions. Patients underwent bilateral US of the ulnar (at the cubital tunnel and proximal to the tunnel), median and common fibular nerves to measure thickening and asymmetry. We found that nerve thickening was more severe in patients with a high bacillary load (multibacillary) and in those with previous reactions. Nerve asymmetry measurements were greater in the patients with previous reactions. Asymmetry did not differ significantly between the paucibacillary and multibacillary patients, demonstrating that asymmetry is a characteristic of leprosy neuropathy regardless of its classification.
Collapse
Affiliation(s)
- Helena Barbosa Lugão
- Dermatology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Marcello Henrique Nogueira-Barbosa
- Radiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, São Paulo, Brazil
| | - Wilson Marques Jr.
- Department of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Norma Tiraboschi Foss
- Dermatology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marco Andrey Cipriani Frade
- Dermatology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
37
|
de Macedo CS, Anderson DM, Pascarelli BM, Spraggins JM, Sarno EN, Schey KL, Pessolani MCV. MALDI imaging reveals lipid changes in the skin of leprosy patients before and after multidrug therapy (MDT). JOURNAL OF MASS SPECTROMETRY : JMS 2015; 50:1374-85. [PMID: 26634971 DOI: 10.1002/jms.3708] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/17/2015] [Indexed: 05/28/2023]
Abstract
Leprosy still represents a health problem in several countries. Affecting skin and peripheral nerves, it may lead to permanent disabilities. Disturbances on skin lipid metabolism in leprosy were already observed; however, the localization and distribution of lipids could not be accessed. The role of lipids on infectious disease has been fully addressed only recently, as they directly influence immune response. Matrix-assisted laser desorption/ionization imaging mass spectrometry provides a powerful tool to localize and identify lipids in tissues. The aim of this work was to study and compare the changes in lipid distribution of skin biopsies taken from leprosy patients before and after multidrug therapy (MDT). Different species of phosphatidic acid, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, sphingomyelin and phosphatidylcholine were detected. Differences in skin lipid signal intensities, as well as in their localization, were observed before and after MDT in every patient. In general, lipid distribution in the skin after MDT had a pattern similar to control skin samples, where most of the lipids were located in the upper part of the dermis and epidermis. This study opens paths to a better understanding of lipid functions in leprosy pathogenesis and immune response.
Collapse
Affiliation(s)
- Cristiana S de Macedo
- Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Institute (IOC) - Cellular Microbiology Laboratory, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - David M Anderson
- Mass Spectrometry Research Center, Vanderbilt University, Nashville, TN, USA
| | - Bernardo M Pascarelli
- Oswaldo Cruz Institute (IOC) - Leprosy Laboratory, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Jeffrey M Spraggins
- Mass Spectrometry Research Center, Vanderbilt University, Nashville, TN, USA
| | - Euzenir N Sarno
- Oswaldo Cruz Institute (IOC) - Leprosy Laboratory, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Kevin L Schey
- Mass Spectrometry Research Center, Vanderbilt University, Nashville, TN, USA
| | - Maria Cristina V Pessolani
- Oswaldo Cruz Institute (IOC) - Cellular Microbiology Laboratory, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
38
|
Shen L, Masih S, Patel DB, Matcuk GR. MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon's canal. Clin Imaging 2015; 40:263-74. [PMID: 26995584 DOI: 10.1016/j.clinimag.2015.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/12/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
Abstract
Ulnar neuropathy is a common and frequent reason for referral to hand surgeons. Ulnar neuropathy mostly occurs in the cubital tunnel of the elbow or Guyon's canal of the wrist, and it is important for radiologists to understand the imaging anatomy at these common sites of impingement. We will review the imaging and anatomy of the ulnar nerve at the elbow and wrist, and we will present magnetic resonance imaging examples of different causes of ulnar neuropathy, including trauma, overuse, arthritis, masses and mass-like lesions, and systemic diseases. Treatment options will also be briefly discussed.
Collapse
Affiliation(s)
- Luyao Shen
- Department of Radiologic Sciences, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095
| | - Sulabha Masih
- Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-5313
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-5313.
| |
Collapse
|
39
|
Payne R, Baccon J, Dossett J, Scollard D, Byler D, Patel A, Harbaugh K. Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings. J Neurosurg 2015; 123:1238-43. [DOI: 10.3171/2014.9.jns142210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hansen’s disease, or leprosy, is a chronic infectious disease with many manifestations. Though still a major health concern and leading cause of peripheral neuropathy in the developing world, it is rare in the United States, with only about 150 cases reported each year. Nevertheless, it is imperative that neurosurgeons consider it in the differential diagnosis of neuropathy.
The causative organism is Mycobacterium leprae, which infects and damages Schwann cells in the peripheral nervous system, leading first to sensory and then to motor deficits. A rare presentation of Hansen’s disease is pure neuritic leprosy. It is characterized by nerve involvement without the characteristic cutaneous stigmata. The authors of this report describe a case of pure neuritic leprosy presenting as ulnar nerve neuropathy with corresponding radiographic, electrodiagnostic, and histopathological data.
This 11-year-old, otherwise healthy male presented with progressive right-hand weakness and numbness with no cutaneous abnormalities. Physical examination and electrodiagnostic testing revealed findings consistent with a severe ulnar neuropathy at the elbow. Magnetic resonance imaging revealed diffuse thickening and enhancement of the ulnar nerve and narrowing at the cubital tunnel. The patient underwent ulnar nerve decompression with biopsy. Pathology revealed acid-fast organisms within the nerve, which was pathognomonic for Hansen’s disease. He was started on antibiotic therapy, and on follow-up he had improved strength and sensation in the ulnar nerve distribution.
Pure neuritic leprosy, though rare in the United States, should be considered in the differential diagnosis of those presenting with peripheral neuropathy and a history of travel to leprosy-endemic areas. The long incubation period of M. leprae, the ability of leprosy to mimic other conditions, and the low sensitivity of serological tests make clinical, electrodiagnostic, and radiographic evaluation necessary for diagnosis. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury.
Collapse
Affiliation(s)
| | | | | | - David Scollard
- 5National Hansen’s Disease Programs Laboratory, Baton Rouge, Louisiana
| | - Debra Byler
- 4Neurology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | | | | |
Collapse
|
40
|
Marques IB, Giovannoni G, Marta M. Mononeuritis multiplex as the first presentation of refractory sarcoidosis responsive to etanercept. BMC Neurol 2014; 14:237. [PMID: 25494723 PMCID: PMC4275932 DOI: 10.1186/s12883-014-0237-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several disorders may present with mononeuritis multiplex and the etiological diagnosis can be challenging. CASE PRESENTATION We report a 42 year-old female who presented with severe lower limb neuropathic pain, asymmetric weakness and sensory impairment and was diagnosed with mononeuritis multiplex. Biopsy showed a granulomatous vasculitic process with eosinophils, scarce granulomata and axonal neuropathy and granulomatosis with poliangiitis was assumed. Steroids, cyclophosphamide, alemtuzumab, azathioprine, mycophenolate mofetil and rituximab were used, all with transient and insufficient response. Skin biopsy performed in a further exacerbation allowed sarcoidosis diagnosis. Infliximab and, later, adalimumab induced good clinical and laboratorial response, but neutralizing antibodies developed to both drugs, so etanercept was tried with good clinical response. CONCLUSIONS To the best of our knowledge, this is the first report of sarcoidosis successfully treated with etanercept. This drug may be considered in refractory sarcoidosis after other TNF-α inhibitors failure, having the advantage of not being associated with neutralizing antibodies development.
Collapse
Affiliation(s)
- Inês Brás Marques
- Queen Mary University London, Blizard Institute, 4 Newark Street, London, E1 1AT, UK.
| | - Gavin Giovannoni
- Queen Mary University London, Blizard Institute, 4 Newark Street, London, E1 1AT, UK.
| | - Monica Marta
- Queen Mary University London, Blizard Institute, 4 Newark Street, London, E1 1AT, UK.
| |
Collapse
|
41
|
Relationship between growth factors and its implication in the pathogenesis of leprosy. Microb Pathog 2014; 77:66-72. [PMID: 25457797 DOI: 10.1016/j.micpath.2014.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/07/2014] [Accepted: 10/15/2014] [Indexed: 11/23/2022]
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae which affects the skin and peripheral nervous system. The immune response of the host determines the clinical course of the disease. The tuberculoid form is the result of high cell-mediated immunity characterized by a Th1 response, whereas the lepromatous form is characterized by low cell-mediated immunity and a Th2 humoral response. The neural damage established produces marked changes in the expression of growth factors such as nerve growth factor (NGF) and its receptors (NGF-R). The expression of NGF, associated with the expression of Th1 and Th2 cytokines, might be involved in the tissue damage caused by the bacillus. Therefore, the objective of this study was to correlate the immunoexpression patterns of NGF and NGF-R in the different clinical forms of leprosy, and to associate the findings with the in situ expression of TGF-β and clinical classification of the disease. TGF-β, NGF and NGF-R immunoexpression was analyzed by immunohistochemistry in paraffin-embedded material. Most patients were males with a mean age of 40.7 years. TGF-β levels were significantly higher in the lepromatous forms. No significant difference in the immunoexpression of NGF or NGF-R was observed between the clinical forms, but expression tended to be higher at the lepromatous pole. There was a significant positive correlation between NGF and NGF-R in the different clinical forms of leprosy. A significant positive correlation was observed between NGF, NGF-R and TGF-β. It can be concluded that, even existing evidence on the role of these molecules in the clinical spectrum of leprosy.
Collapse
|
42
|
Abstract
Infectious causes of peripheral nervous system (PNS) disease are underrecognized but potentially treatable. Heightened awareness educed by advanced understanding of the presentations and management of these infections can aid diagnosis and facilitate treatment. In this review, we discuss the clinical manifestations, diagnosis, and treatment of common bacterial, viral, and parasitic infections that affect the PNS. We additionally detail PNS side effects of some frequently used antimicrobial agents.
Collapse
Affiliation(s)
- Kate T. Brizzi
- Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Lyons
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
43
|
Cabalar M, Yayla V, Ulutas S, Senadim S, Oktar AC. The clinical & neurophysiological study of leprosy. Pak J Med Sci 2014; 30:501-6. [PMID: 24948967 PMCID: PMC4048494 DOI: 10.12669/pjms.303.5354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/23/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate neurological and neurophysiological features of leprosy. METHODS Seventy seven hospitalized leprosy patients (52 male, 25 female) were examined neurological and neurophysiologically between 2010 and 2012. Standard procedures were performed for evaluating sensory and motor conduction studies to all patients. Motor studies were carried out on median, ulnar, tibial and common peroneal nerves. Sensory studies were carried out on median, ulnar and sural nerves. Sympathetic skin response (SSR) recordings on both hands and feet, and the heart rate (R-R) interval variation (RRIV) recordings on precordial region were done in order to evaluate the autonomic dysfunction. RESULTS The mean age was 59.11±14.95 years ranging between 17 and 80 years. The mean duration of disease was 35.58±18.30 years. Clinically, the patients had severe deformity and disability. In neurophysiological examinations, sensory, motor conduction studies of the lower extremities were found to be more severely affected than upper, and sensory impairment predominated over motor. Abnormal SSRs were recorded in 63 (81.8%) cases of leprosy. Abnormal RRIVs were recorded in 41 (53.2%) cases and abnormal RRIVs with hyperventilation were recorded in 55 (71.4%) cases of leprosy. Significant differences were found between SSR and sensory conduction parameters of median, ulnar nerves as well as motor conduction parameters of median, ulnar and peroneal nerves (p<0.05). CONCLUSION Peripheral nervous system dysfunction is accompanied by autonomic nervous system dysfunction in leprosy patients. Sympathetic involvement may predominate over parasympathetic involvement.
Collapse
Affiliation(s)
- Murat Cabalar
- Dr. Murat Cabalar, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Vildan Yayla
- Dr. Vildan Yayla, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Samiye Ulutas
- Dr. Samiye Ulutas, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Songul Senadim
- Dr. Songul Senadim, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Ayla Culha Oktar
- Dr. Ayla Culha Oktar, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| |
Collapse
|
44
|
Pedraza Hueso M, Hinojosa Mena-Bernal C, Hernández-Laín A, Guerrero Peral A. Mononeuritis multiplex due to leprosy: A case of atypical presentation. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2012.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
45
|
Locher H, de Groot JCMJ, van Iperen L, Huisman MA, Frijns JHM, Chuva de Sousa Lopes SM. Distribution and development of peripheral glial cells in the human fetal cochlea. PLoS One 2014; 9:e88066. [PMID: 24498246 PMCID: PMC3909285 DOI: 10.1371/journal.pone.0088066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022] Open
Abstract
The adult human cochlea contains various types of peripheral glial cells that envelop or myelinate the three different domains of the spiral ganglion neurons: the central processes in the cochlear nerve, the cell bodies in the spiral ganglia, and the peripheral processes in the osseous spiral lamina. Little is known about the distribution, lineage separation and maturation of these peripheral glial cells in the human fetal cochlea. In the current study, we observed peripheral glial cells expressing SOX10, SOX9 and S100B as early as 9 weeks of gestation (W9) in all three neuronal domains. We propose that these cells are the common precursor to both mature Schwann cells and satellite glial cells. Additionally, the peripheral glial cells located along the peripheral processes expressed NGFR, indicating a phenotype distinct from the peripheral glial cells located along the central processes. From W12, the spiral ganglion was gradually populated by satellite glial cells in a spatiotemporal gradient. In the cochlear nerve, radial sorting was accomplished by W22 and myelination started prior to myelination of the peripheral processes. The developmental dynamics of the peripheral glial cells in the human fetal cochlea is in support of a neural crest origin. Our study provides the first overview of the distribution and maturation of peripheral glial cells in the human fetal cochlea from W9 to W22.
Collapse
Affiliation(s)
- Heiko Locher
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - John C. M. J. de Groot
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Liesbeth van Iperen
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Margriet A. Huisman
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johan H. M. Frijns
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Susana M. Chuva de Sousa Lopes
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| |
Collapse
|
46
|
Pandey S, Nayak R, Mehndiratta MM. Hansen's disease manifesting as acute distal symmetric microvasculitic polyneuropathy. Clin Neurol Neurosurg 2013; 115:2223-5. [PMID: 23886834 DOI: 10.1016/j.clineuro.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/25/2013] [Accepted: 07/02/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Sanjay Pandey
- Department of Neurology, G.B. Pant Hospital, Delhi University, New Delhi 110002, India
| | | | | |
Collapse
|
47
|
Kar S, Krishnan A, Singh N, Singh R, Pawar S. Nerve damage in leprosy: An electrophysiological evaluation of ulnar and median nerves in patients with clinical neural deficits: A pilot study. Indian Dermatol Online J 2013; 4:97-101. [PMID: 23741664 PMCID: PMC3673401 DOI: 10.4103/2229-5178.110625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Leprosy involves peripheral nerves sooner or later in the course of the disease leading to gross deformities and disabilities. Sadly, by the time it becomes clinically apparent, the nerve damage is already quite advanced. However, if the preclinical damage is detected early in the course of disease, it can be prevented to a large extent. Materials and Methods: We conducted an electrophysiological pilot study on 10 patients with clinically manifest leprosy, in the Dermatology Department of Mahatma Gandhi Institute of Medical Sciences, Sewagram. This study was done to assess the nerve conduction velocity, amplitude and latency of ulnar and median nerves. Results and Conclusion: We found reduced conduction velocities besides changes in latency and amplitude in the affected nerves. Changes in sensory nerve conduction were more pronounced. Also, sensory latencies and amplitude changes were more severe than motor latencies and amplitude in those presenting with muscle palsies. However, further studies are going on to identify parameters to detect early nerve damage in leprosy.
Collapse
Affiliation(s)
- Sumit Kar
- Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| | | | | | | | | |
Collapse
|
48
|
Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am 2013; 24:49-65. [PMID: 24210312 DOI: 10.1016/j.nic.2013.03.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article is a primer on the pathophysiology and clinical evaluation of peripheral neuropathy for the radiologist. Magnetic resonance neurography has utility in the diagnosis of many focal peripheral nerve lesions. When combined with history, examination, electrophysiology, and laboratory data, future advancements in high-field magnetic resonance neurography may play an increasingly important role in the evaluation of patients with peripheral neuropathy.
Collapse
Affiliation(s)
- Tae Chung
- Department of Neurology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | | | | |
Collapse
|
49
|
Wilmshurst JM. Diagnosis and management of pediatric peripheral neuropathies in resource-poor settings. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.12.97] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The diagnosis of a peripheral neuropathy in a child who resides in the majority of resource-poor settings is based on the history taken and the clinical examination. The majority of children, unless they demonstrate additional clinical markers, will lack a more definitive diagnosis beyond the label ‘peripheral neuropathy’. The treatable, typically acquired conditions, which are prevalent in these settings, are the priority to identify. This would include neuroinfections, neuroinflammation, toxins and vitamin deficiencies. The management of children with peripheral neuropathies in resource-poor settings must be approached in a different manner to that of more ‘resource-equipped’ settings. Secondary or tertiary centers are scarce, often significant distances away from the patient, and this leads to long delays before access is possible. Most children present to primary healthcare settings and are seen by practitioners with little training in the features suggestive of a peripheral neuropathy. As such, basic aids to assist the healthcare worker in the early recognition and interventions of a child with a peripheral neuropathy are important. In addition, there must be recognition of the child with a rapidly progressive neuropathy where a life-threatening condition is present, and urgent referral to a tertiary setting made wherever possible.
Collapse
Affiliation(s)
- Jo M Wilmshurst
- Pediatric Neurology Department, Red Cross War Memorial Children’s Hospital, University of Cape Town, 7700, Cape Town, South Africa
| |
Collapse
|
50
|
ANTUNES-FERREIRA NATHALIE, MATOS VÍTORM, SANTOS ANALUÍSA. Leprosy in individuals unearthed near the Ermida de Santo André and Leprosarium of Beja, Portugal. ANTHROPOL SCI 2013. [DOI: 10.1537/ase.130702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- NATHALIE ANTUNES-FERREIRA
- Instituto Superior de Ciências da Saúde Egas Moniz, Caparica
- Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra
| | - VÍTOR M.J. MATOS
- Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra
| | - ANA LUÍSA SANTOS
- Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra
- Department of Life Sciences, University of Coimbra, Coimbra
| |
Collapse
|