Bilateral facial synkinesis in leprosy.

Leprosy is an important cause of cranial nerve palsy in endemic areas where it may be seen in upto 17.6% patients. The authors herein describe a rare case of bilaterally symmetrical facial synkinesis with video documentation and modified blink reflex. A 35-year-old gentleman presented with numbness involving right half of his face for 8 months and abnormal stretching sensations over both sides of his nose for one and a half months. Sensory and motor involvement of the right trigeminal nerve was detected along with bilaterally symmetrical facial synkinesis involving orbicularis oculi and nasalis. R(1) and R(2) responses consistent with mis-reinnervation were recorded on the left-side using orbicularis oculi and nasalis muscles. Skin biopsy revealed acid-fast bacilli and sural nerve biopsy, the presence of granulomas. After 3 months of follow-up on WHO multi-drug therapy, an improvement in facial sensations was observed but without any change in facial synkinetic movements.

A case of leprosy with multiple cranial neuropathy mimicking Melkerson Rosenthal syndrome.

Involvement of cranial nerves is not uncommon in leprosy with trigeminal and facial nerves being commonly affected. Other cranial nerves can also be involved especially in longstanding cases of leprosy towards the lepromatous pole. Herein, we report a case of leprosy with multiple cranial neuropathy mimicking Melkerson Rosenthal syndrome.

Bilateral lagophthalmos in leprosy: is it a rare phenomenon?

Lagophthalmos is one of the well known complications of leprosy due to involvement of the facial nerve. Herein, we report three cases of bilateral lagophthalmos due to leprosy which presented to us within a span of just three months. In all these cases, lagophthalmos was not the presenting complaint and it was detected by the treating doctor during examination. This report is being presented to highlight the importance of cranial nerve examination in all cases of leprosy as at times early changes of lagophthalmos may go unnoticed by the patient.

Lepromatous leprosy with bilateral facial nerve palsy and hyperthyroidism.

Bilateral lagophthalmos secondary to facial nerve is extremely uncommon. Further, the aetiology in most of these cases is of central origin unlike the peripheral involvement in leprosy. A patient of lepromatous leprosy (LL) may be euthyroid or hypothyroid on account of leprous involvement of the thyroid gland. A case of LL with bilateral lagophthalmos and hyperthyroidism is reported.

Blink reflex, H-reflex and nerve-conduction alterations in leprosy patients.

Peripheral nerve lesions are the most important cause of disability in leprosy patients. Electrophysiological studies are used in the diagnosis and prognosis of neuropathy. Nerve conduction is the most frequently used electrophysiological test method to detect neuropathy, although it evaluates only a part of the peripheral nervous system. Blink reflex and H-reflex are electrophysiological tests which evaluate facial and trigeminal nerve function. This study determined the frequencies of blink reflex, H-reflex and motor and sensory nerve conduction alterations in twenty five heterogeneous, clinic patients with lepromatous leprosy and a control group of 20 healthy subjects. Study results showed a decrease in motor and sensory nerve conduction in 40% and 30%, respectively. In blink reflex (BR), right R1 was altered in latency in 20% of patients, left R1 in 20%, right ipsilateral R2 in 16%, left ipsilateral R2 in 20%, and right and left contralateral R2 were altered in 32% of patients. There was an absence of H-reflex in 16% (n = 4) and prolonged latency in 4% (n = 1).

Leprosy affects facial nerves in a scattered distribution from the main trunk to all peripheral branches and neurolysis improves muscle function of the face.

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve's affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve's main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.

Leprosy affects facial nerves in a scattered distribution from the main trunk to all peripheral branches and neurolysis improves muscle function of the face

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve's affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve's main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.

[Bilateral lagophthalmos in lepromatous leprosy. Case report]. / Lagoftalmos bilateral en paciente con lepra lepromatosa. Caso clínico.

CASE REPORT: A case of bilateral facial palsy with paralytic ectropion, lagophthalmos and corneal damage secondary to corneal exposure in a long-standing patient with lepromatous leprosy is presented. Correction of paralytic ectropion was performed by medial cantoplasty, tarsal strip and Medpor lower eyelid spacer implantation. Lagophthalmos was corrected by gold weight implant in the upper tarsus. DISCUSSION: Ocular findings in leprosy appear in 72% of patients. Facial nerve palsy occurs in 3-19.8%, being bilateral in 5%. In long standing cases with corneal complications secondary to exposure, surgical treatment is required.

Lagoftalmos bilateral en paciente con lepra lepromatosa. Caso clínico / Bilateral lagophthalmos inlepromatous leprosy. Case report

CASE REPORT: A case of bilateral facial palsy with paralytic ectropion, lagophthalmos and corneal damage secondary to corneal exposure in a long-standing patient with lepromatous leprosy is presented. Correction of paralytic ectropion was performed by medial cantoplasty, tarsal strip and Medpor lower eyelid spacer implantation. Lagophthalmos was corrected by gold weight implant in the upper tarsus. DISCUSSION: Ocular findings in leprosy appear in 72 per cent of patients. Facial nerve palsy occurs in 3-19.8 per cent, being bilateral in 5 per cent. In long standing cases with corneal complications secondary to exposure, surgical treatment is required.

Avaliação neurologica completa na neuropatia hanseniana / Complete neurologica assessment in Hansen´s disease

Dada a importância da afectação neurológica da Doença de Hansen, os autores tentam descrever neste artigo a forma de realizar uma exploração neurológica completa. Para efeito, são focados os pontos fundamentais desta prática, como a palpação e identificação dos nervos periféricos engrossados, o estudo da sensibilidade superficial e profunda, a exploração da mobilidade voluntária, o exame dos reflexos e a avaliação dos processos neutróficos secundários ao trauma. Devemos destacar que, na maioria das situações, para o diagnóstico da doença e fundamentalmente no trabalho de campo, realizaremos uma exploração baseada em todos estes pontos, embora muito mais simplificada. Como anexo do artigo serão apresentados os resultados obtidos com a exploração neurológica de 71 doentes controlados no Sanatório Fontilles.

The stapedial reflex as a topographical marker of proximal involvement of the facial nerve in leprosy. A pilot study.

This study aimed to determine the parameters necessary for a study of stapedial reflexes in leprosy patients to ascertain if the facial nerve is involved more proximally than the stylomastoid foramen. It involved leprosy patients with and without facial nerve involvement and non-leprosy controls. Clinical examination of the patients' ears, a tympanogram and audiogram to exclude conductive and sensorineural deafness, followed by the measurement of a stapedial reflex and the acoustic reflex threshold, were carried out. The number of absent reflexes and the acoustic reflex thresholds did not differ between the three groups of subjects. A definitive study would be logistically impossible. Suggestions are made as to more exact patient selection in order to demonstrate any stapedial reflex changes due to leprosy. The findings of this study do not suggest that facial nerve pathology extends proximally to the stylomastoid foramen, unless such proximal involvement is subclinical to the detection methods used.

Audiovestibular system, fifth and seventh cranial nerve involvement in leprosy.

Thirty-nine patients with leprosy and fifteen sex- and age-matched controls were investigated for disorders of the fifth and seventh cranial nerves and that of the audiovestibular system. Sensorineural hearing loss found to be of cochlear origin was detected in eight (22%) of the patients with leprosy compared to none in the control group (p > 0.05). Vestibular dysfunction was noted in four patients (11.1%) compared to none in the control group (p < or = 0.05). Two cases were found to have fifth nerve involvement and one (2.8%) had seventh nerve involvement. None in the control group had fifth or seventh nerve deficit.

Estudo dacriocistográfico em pacientes portadores de hanseníase / Dacriocystographic study in patients bearing Hansen's disease

Com a finalidade de se pesquisar a possibilidade de um comprometimento precoce do nervo facial e uma consequente reduçäo da funçäo da bomba lacrimal, em pacientes portadores de hanseníase, foi realizado um estudo dacriocistográfico em 2 grupos de pacientes: portadores e näo portadores desta moléstia. Após análise estatística dos resultados, concluiu-se que o referido exame näo é válido na comprovaçäo do comprometimento nervoso - nervo facial - e que o tempo pré-determinado de 10 minutos para a realizaçäo da última chapa do exame de dacriocistografia, realizado com o contraste Hypaque a 75%, deve ser novamente avaliado em estudos futuros

Leoprosy- clinical aspectos of nerve involvement.

Leprosy is the cause of the commonest peripheral neuropathy. The predilection of Mycobacterium leprae for nerve tissue accounts for the clinical features that are most dreaded and most characteristic of the disease. Were it not for the progressive destruction of peripheral nerve trunks and the consequences of this, leprosy would largely remain a cutaneous condition of cosmetically unsightly hypopigmented or erythematous areas and aggregations of nodular thickenings. The neurologic damage in leprosy is confined to postganglionic changes. The central nervous system is protected, although rarely in experimental situations organisms have been reported in cerebral tissues.