1/25. facial nerve pathology in leprosy: searching for the proximal extent of the lesion in facial nerve biopsies.A light and electron microscope study was made of resin embedded facial nerves in three cases of leprosy involving the facial nerve. The patients had irreversible facial nerve palsies and had requested facial reconstruction. No consistent pattern of nerve fibre damage was found. In one case the temporozygomatic was affected, but the cervical branch was normal, suggesting the damage begins distally. In two cases the loss of nerve fibres in the trunk and all branches was similar, and is likely to emanate from damage at a more proximal site. The presence of increased numbers of unmyelinated axons, often in clusters, is evidence of regeneration. These axons probably have the potential to develop into functional myelinated fibres provided that they can innervate a viable distal target such as a muscle graft. These regenerating axons are distal to the stylomastoid foramen suggesting that the most proximal level of involvement of the facial nerve could be intracranial. The finding of a more proximal level of nerve involvement, implies that the mis-reinnervation seen in partially recovered facial nerve palsies in leprosy, could be due to some regenerating axons being mis-directed at the level of the main trunk bifurcation.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/25. Generalized annular borderline tuberculoid leprosy and update in management of Hansen's disease.We describe a patient with widespread borderline tuberculoid leprosy and significant peripheral nerve involvement. Despite the presence of widespread lesions, Fite stains and polymerase chain reaction studies were initially negative. We discuss the diagnosis and treatment of leprosy including recent changes in treatment regimens and duration.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
3/25. Three cases of pure neuritic (PN) leprosy at detection in which skin lesions became visible during their course.Pure neuritic leprosy (PN leprosy) is a type of leprosy with nerve involvement, but without obvious skin lesions. It is not uncommon in the south of bangladesh, but its nature is less recognized than that in other types of leprosy. male is dominant on its occurrence with higher disability grading. The histopathological study shows that the entire spectrum can be observed in nerves of PN leprosy. There was no relation among clinical parameters, such as the number and distribution of affected nerves, the immune response and its histopathology. Therefore the treatment of PN leprosy is not well-established at field level. Out of 1,741 newly detected cases by Dhanjuri leprosy Project--Khulna Branch (PIME Sisters) in Khulna, the south of bangladesh from 1994 to 1998, 141, or 8.10% were diagnosed as PN leprosy. 6 cases out of 1,741, or 0.34% were canceled afterwards because of wrong diagnosis, of which one misdiagnosed as PN leprosy. Three cases out of 140 of primary neuritic leprosy proved to have obvious skin lesions some time after their treatment started. The details of the three cases are described in this paper.- - - - - - - - - - ranking = 0.1875keywords = nerve (Clic here for more details about this article) |
4/25. Location of the extracranial extent of leprous facial nerve pathology may allow leprous facial palsy to be reanimated by free muscle transfer.leprosy is a mycobacterial nerve and skin infection, which can be eradicated by antibiotics. Some patients affected by leprosy, once cured, have residual nerve impairment with paralysis and sensory neuropathy. A series of patients with facial nerve paralysis, investigated using clinical, histological and electrophysiological techniques, demonstrated that the nerve pathology was distal to the section of main trunk prior to its bifurcation. Facial reanimation was achieved with a free gracilis-muscle transfer, coapting its motor nerve to the ipsilateral facial nerve trunk proximal to the site of the leprosy pathology, with a moderate clinical result.- - - - - - - - - - ranking = 0.625keywords = nerve (Clic here for more details about this article) |
5/25. Primary neuritic leprosy in a black South African.A case of primary neuritic leprosy in a black South African is described, in which the multiple peripheral nerves were affected. The clinical picture and electrophysiological studies are in keeping with a picture of mononeuritis multiplex. Selective involvement of the facial nerve branches with normal blink reflex latencies was observed. The biopsy of the sural nerve disclosed features most consistent with borderline leprosy.- - - - - - - - - - ranking = 0.1875keywords = nerve (Clic here for more details about this article) |
6/25. Isolated superficial peroneal nerve lesion in pure neural leprosy: case report.patients with leprosy may have only nerve involvement without skin changes. These cases are known as pure neural leprosy and can be seen in 10% of leprosy patients. Most patients have mononeuritic or multiple mononeuritic neuropathy patterns. The isolated lesion of the superficial peroneal nerve is uncommonly seen. We report a patient with involvement of this nerve in which there was no thickening of superficial nerves. The performed nerve biopsy showed inflammatory infiltration, loss of fibers and presence of mycobacterium leprae. We believe that in prevalent leprosy countries we should take in mind the possibility of isolated pure neural leprosy in some patients without skin lesion. In these cases the diagnosis of leprosy is impossible on clinical grounds and nerve biopsy is mandatory.- - - - - - - - - - ranking = 0.625keywords = nerve (Clic here for more details about this article) |
7/25. A case of isolated tuberculoid leprosy of antebrachial medial cutaneous nerve.leprosy is an infectious disease of prevalence still high in endemic areas in brazil. The neurological presentation depends on the involved nerve and is usually associated with skin lesions and the formation of multiple abscesses. We present a case of isolated tuberculoid leprosy, discuss the occurrence, the differential diagnosis and the treatment of this rare presentation and reaffirm the importance of considering leprosy in the differential diagnosis of patients with polyneuropathy or nerve enlargement with no skin lesions.- - - - - - - - - - ranking = 0.375keywords = nerve (Clic here for more details about this article) |
8/25. Pure neural leprosy presenting with multiple nerve abscesses.A 22-year-old male student presented to us with patchy sensory loss over the dorsum of right foot of 6 months' duration and swelling over the left index finger of 2 months' duration. Subsequently, a week later, he developed a painful swelling over the left forehead and right leg. On examination, tender soft, fluctuant subcutaneous saccular swellings were seen varying in size from 2x2 cm to 5x5 cm over the left supratrochlear, left radial cutaneous nerve, left digital nerve, right superficial peroneal nerve and left saphenous nerve. The nerves were tender and thickened above and below these cold swellings (cold nerve abscesses). Nerve biopsy of the left radial cutaneous nerve showed granulomatous infiltrate of epithelioid cells, lymphocytes and caseation necrosis of nerve. No bacilli were demonstrated with acid-fast stain. On the basis of the above findings, a diagnosis of pure neuritic leprosy (BT spectrum) in type 1 lepra reaction with multiple nerve abscesses was made. We present this case of pure neuritic leprosy exhibiting multiple nerve abscesses, for its rarity.- - - - - - - - - - ranking = 0.875keywords = nerve (Clic here for more details about this article) |
9/25. leprosy & gangrene: a rare association; role of anti phospholipid antibodies.BACKGROUND: leprosy still remains an important public health problem for many parts of the world. An association of gangrene with leprosy is a rare one & can have a number of causative mechanisms. We present a case with leprosy & gangrene with positive anti phopholipid antibody titers. CASE PRESENTATION: A 50-year-old non-diabetic, non-hypertensive lady presented with 2 months history of progressive gangrene of bilateral toes. She was found to have madarosis & hypopigmented, hypoaesthetic macular lesions on the upper limb & thighs. Bilateral ulnar & popliteal nerves were thickened. A skin biopsy of the lesions revealed borderline tuberculoid leprosy, slit skin smears revealed a bacteriological index of 1 . She did not have any evidence of thromboembolic episode or atherosclerosis. ACLA was positive at presentation & also on another occasion 6 weeks later. ACLAs were of the IgM type on both occasions. Lupus Anticoagulant & beta2 GPI antibody were negative. DOPPLER of the lower limb arteries did not reveal any abnormality. Patient was successfully treated with multi-drug antileprotics & anticoagulants. CONCLUSION: Infectious APLAs should be recognized as a cause of thrombosis in leprosy. Appropriate anticoagulation can salvage limb function.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
10/25. Persistent reaction in paucibacillary leprosy: case reports.Three patients of histopathologically confirmed borderline-tuberculoid leprosy showing no acid-fast bacilli and with lesions confined to the face, 2 on the cheek and 1 on the forehead, were given multidrug therapy as recommended by the WHO for paucibacillary cases. Within 3 months the lesions showed signs of upgrading (or reversal) reaction which was substantiated by histopathology. In 1 patient the facial nerve was affected leading to facial palsy. The lymphocyte transformation test did not show a significant rise. All 3 patients were given oral prednisolone for periods varying between 5 and 7 months, but the response was poor except in 1 patient in whom the facial palsy responded favourably. injections of sodium antimony gluconate tried in 1 patient after stoppage of steroids did not control the reaction. After 18 months of regular follow-up during therapy, the cutaneous reaction in the patient with facial nerve involvement subsided leaving significant atrophy. However, in the other 2 patients the skin lesion persisted with clinical and histopathological evidence of upgrading reaction. The reasons for the unnatural persistence of reaction in these patients is not clear.- - - - - - - - - - ranking = 0.125keywords = nerve (Clic here for more details about this article) |
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