Subject(s)
Facial Nerve Diseases/pathology , Facial Paralysis/diagnosis , Melkersson-Rosenthal Syndrome/pathology , Biopsy , Diagnosis, Differential , Facial Paralysis/epidemiology , Facial Paralysis/etiology , Granuloma/diagnosis , Granuloma/pathology , Humans , Inflammation/pathology , Leprosy, Lepromatous/complications , Leprosy, Lepromatous/diagnosis , Leprosy, Lepromatous/pathology , Melkersson-Rosenthal Syndrome/diagnosis , Mouth Mucosa/pathology , Sarcoidosis/complications , Sarcoidosis/diagnosis , Sarcoidosis/pathology , Skin/pathology , Skin Diseases/pathologySubject(s)
Acne Vulgaris/chemically induced , Acne Vulgaris/diagnosis , Facial Paralysis/diagnosis , Facial Paralysis/drug therapy , Glucocorticoids/adverse effects , Adult , Dexamethasone/administration & dosage , Dexamethasone/adverse effects , Female , Glucocorticoids/administration & dosage , Humans , Injections, Intramuscular , Male , Methylprednisolone/administration & dosage , Methylprednisolone/adverse effectsABSTRACT
A middle-aged woman was referred to our hospital emergency ward in view of acute onset left faciobrachial weakness. An urgent MRI of the brain was performed, which did not reveal any abnormality and hence a neurology consultation was arranged in order to rule out acute stroke. However, examination and retrospective history taking proved to be a valuable aid in this patient's diagnosis. The incomplete lower motor neuron facial nerve palsy and hand weakness due to leprosy in reaction was confused by the general practitioner as a faciobrachial stroke.
Subject(s)
Facial Paralysis/diagnosis , Facial Paralysis/etiology , Leprosy/complications , Stroke/diagnosis , Ulnar Neuropathies/diagnosis , Ulnar Neuropathies/etiology , Anti-Inflammatory Agents/therapeutic use , Diagnosis, Differential , Facial Nerve , Facial Paralysis/drug therapy , Female , Humans , Leprostatic Agents/therapeutic use , Leprosy/drug therapy , Middle Aged , Prednisolone/therapeutic use , Treatment Outcome , Ulnar Neuropathies/drug therapySubject(s)
Eyelid Diseases/diagnosis , Facial Paralysis/diagnosis , Leprosy, Lepromatous/complications , Adult , Humans , MaleSubject(s)
Facial Paralysis/complications , Fasciculation/complications , Functional Laterality , Polyradiculoneuropathy/complications , Aged , Facial Paralysis/diagnosis , Facial Paralysis/therapy , Fasciculation/diagnosis , Fasciculation/therapy , Female , Humans , Leprosy, Multibacillary/complications , Polyradiculoneuropathy/diagnosis , Polyradiculoneuropathy/therapyABSTRACT
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.
Subject(s)
Facial Nerve/physiopathology , Facial Paralysis/diagnosis , Leprosy/complications , Reflex, Abnormal , Stapedius/innervation , Adolescent , Adult , Facial Paralysis/etiology , Facial Paralysis/physiopathology , Female , Humans , Leprosy/diagnosis , Male , Middle Aged , Neurologic Examination/methods , Pilot Projects , Reference Values , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
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.
Subject(s)
Facial Nerve/pathology , Facial Paralysis/pathology , Leprosy, Borderline/pathology , Leprosy, Tuberculoid/pathology , Aged , Biopsy, Needle , Facial Paralysis/diagnosis , Female , Humans , Leprosy, Borderline/surgery , Leprosy, Tuberculoid/surgery , Male , Middle Aged , Prognosis , Plastic Surgery Procedures , Severity of Illness Index , Treatment OutcomeABSTRACT
Bilateral facial nerve palsy is relatively uncommon and may occur in association with a variety of neurological, infectious, neoplastic or degenerative disorders. Presentation is made of 4 cases of bilateral facial diplegia due to a refractory anemia with excess of blasts, a Lyme disease and a tuberculoid leprosy. In one of these patients the cause of bilateral seventh-nerve palsy was unknown (Bell's palsy). Facial palsy returned to normal after treatment with steroids in 3 patients. The patient with myelodysplastic syndrome did not show any improvement and died 6 months after diagnosis.
Subject(s)
Facial Paralysis/etiology , Adult , Aged , Anemia, Refractory, with Excess of Blasts/complications , Electromyography , Facial Paralysis/diagnosis , Facial Paralysis/therapy , Female , Humans , Leprosy, Tuberculoid/complications , Lyme Disease/complications , Male , Polyradiculoneuropathy/complicationsABSTRACT
This study demonstrates that the platysma is occasionally palsied in leprosy and that this only occurs when the facial nerve already has some other palsy. That there needs to be a facial palsy before there can be a platysma palsy is strongly suggested, in that there was no case of an isolated platysma palsy. Patients, regardless of age or other factors, could mimic a platysma contraction. This obviates the need for electrical testing to examine for a platysma palsy. It also means that a nonfunctioning platysma on clinical examination is, in fact, a palsied platysma. While lagophthalmos is regularly examined for, and any obvious facial paresis would be noticed, less severe forms of facial muscle paresis will only be found if formally examined for. The mechanism whereby the facial nerve is involved in leprosy is not clarified, but our findings suggest that proximal spread of a lesion that began in the zygomatico-temporal branches and reaches to the facial nerve trunk is more likely than new lesions developing de novo in other peripheral facial nerve branches. That the primary lesion is within the facial nerve trunk in all cases but we only see the frequent zygomatic sequelae due to secondary factors is not excluded.
Subject(s)
Cranial Nerves , Leprosy/diagnosis , Adolescent , Adult , Aged , Child , Facial Nerve Diseases/diagnosis , Facial Paralysis/diagnosis , Female , Humans , Leprosy, Borderline/diagnosis , Leprosy, Lepromatous/diagnosis , Leprosy, Tuberculoid/diagnosis , Male , Middle AgedABSTRACT
This study demonstrates that the platysma is occasionally palsied in leprosy and that this only occurs when the facial nerve already has some other palsy. That there needs to be a facial palsy before there can be a platysma palsy is strongly suggested, in that there was no case of an isolated platysma palsy. Patients, regardless of age or other factors, could mimic a platysma contraction. This obviates the need for electrical testing to examine for a platysma palsy. It also means that a nonfunctioning platysma on clinical examination is, in fact, a palsied platysma. While lagophthalmos is regularly examined for, and any obvious facial paresis would be noticed, less severe forms of facial muscle paresis will only be found if formally examined for. The mechanism whereby the facial nerve is involved in leprosy is not clarified, but our findings suggest that proximal spread of a lesion that began in the zygomatico-temporal branches and reaches to the facial nerve trunk is more likely than new lesions developing de novo in other peripheral facial nerve branches. That the primary lesion is within the facial nerve trunk in all cases but we only see the frequent zygomatic sequelae due to secondary factors is not excluded.
Subject(s)
Male , Female , Humans , Leprosy, Borderline/diagnosis , Leprosy, Tuberculoid/diagnosis , Leprosy, Lepromatous/diagnosis , Leprosy/diagnosis , Facial Paralysis/diagnosisABSTRACT
It is well known that ocular changes occur in leprosy, but data on their frequency differ very considerably (0.8-100%). Two groups of lepers in Togo were examined: first, 206 lepers who had had the disease for approximately 10 years and a second group (101) patients who had been suffering from it for approximately 24 years and had severe mutilations. It became apparent that sooner or later all lepers suffer from ocular complications. The following symptoms were found: loss of the eyebrows in 40.8% (42.6%), loss of the eyelashes in 29.6% (34.6%), lagophthalmos caused by involvement of the 7th cranial nerve in 21.4% (31.7%), corneal changes in 34.5% (49.5%), uveitis in 5.8% (19.8%), atrophy of the optic nerve in 12.6% (11.9%) and cataract in 21.8% (12.8%). The duration of the disease, the type of leprosy and the time when treatment was started are obviously the main factors associated with ocular changes in leprosy.