1/18. 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) |
2/18. 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) |
3/18. 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) |
4/18. A case report of fatal dapsone-induced agranulocytosis in an Indian mid-borderline leprosy patient.Fatal agranulocytosis in an Indian male receiving 100mg of dapsone daily, hospitalized for mid-borderline leprosy in type I reaction with triple nerve paralysis is reported. Various case reports concerning dapsone-induced agranulocytosis are reviewed.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
5/18. leprosy and psoriasis: an enigmatic relationship.The relationship between leprosy and psoriasis has been controversial since ancient times. Based on the fundamental importance of nerve involvement in the pathogenesis of leprosy and psoriasis, it has been hypothesized that leprosy patients may be protected from developing psoriasis. There are only sporadic reports of coexistence of these two diseases as evidence of this negative association. We report a 64-year-old male patient with borderline leprosy and psoriasis. Recent advances in the elucidation of pathogenesis of both diseases have contributed to the understanding of this enigmatic relationship. Various genetic, immunological, and structural alterations in leprosy and psoriasis as discussed could be responsible for the rare co-existence of these two diseases in a given patient.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
6/18. A case of post-partum borderline tuberculoid leprosy complicated by a median nerve abscess, peptic ulceration and rifampicin-induced haemolytic renal failure.We report a case of borderline tuberculoid leprosy complicated by a median nerve abscess, acute renal failure secondary to rifampicin-induced haemolysis and duodenal ulceration secondary to steroid use. Rifampicin induced hameolysis is a rare and probably under-reported complication of leprosy multi-drug therapy. It should be considered when patients complain of flu-like symptoms after taking their monthly rifampicin.- - - - - - - - - - ranking = 0.3125keywords = nerve (Clic here for more details about this article) |
7/18. leprosy with neurofibromatosis--a diagnostic dilemma.The coexistence of leprosy with neurofibromatosis is a rare finding and can pose a diagnostic dilemma. Neurofibromatosis coexisting with borderline tuberculoid leprosy has previously not been reported. We report such a case in a 13-year-old boy where biopsy of clinically uninvolved nerve revealed the presence of acid-fast bacilli. A careful diagnostic workup is needed in such cases to ensure proper treatment. Both disorders affect schwann cells and their relationship merits further consideration.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
8/18. Chronic inflammatory joint disease revealing borderline leprosy.Musculoskeletal symptoms are not infrequent in leprosy and, when inaugural, may be difficult to differentiate from other conditions, most notably rheumatoid arthritis. We report the case of a 24 year-old man with a 5 year history of intermittent inflammatory arthritis and fever. Physical findings and radiographs were normal initially. Several years later, he had severe wasting of the hand muscles, stocking-glove sensory loss, burn scars on the hands, and plantar ulcers. Electrophysiological test results indicated sensory-motor neuropathy with predominant demyelination. Laboratory tests showed inflammation without immunological abnormalities. A prominent endoneurial inflammatory infiltrate composed of mononuclear cells was seen on a nerve biopsy specimen, suggesting leprosy. A family study then revealed that the patient's aunt had been diagnosed with leprosy. dapsone, clofazimine, and rifampin were given. The joint manifestations and laboratory tests for inflammation improved. However, no changes were noted in the neurological symptoms.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
9/18. guillain-barre syndrome-like presentation in borderline leprosy with type-2 reaction.A 46-year-old man with borderline lepromatous leprosy with type-2 reaction being treated with multi-bacilliary-multiple drug therapy and steroids presented with an acute onset of flaccid quadriparesis. A nerve conduction study and CSF analysis were similar to that seen in Guillain Barre syndrome. muscle weakness improved considerably with an increased dose of corticosteroid; after 6 months the patient recovered completely.- - - - - - - - - - ranking = 0.0625keywords = nerve (Clic here for more details about this article) |
10/18. 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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