RESUMO
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.
Assuntos
Agranulocitose/induzido quimicamente , Dapsona/efeitos adversos , Hanseníase Dimorfa/tratamento farmacológico , Evolução Fatal , Humanos , Hanseníase Dimorfa/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
Fifty-six consecutive patients with Guillain-Barré syndrome representing 49% of all cases of peripheral neuropathy (except those due to diabetes mellitus and leprosy) admitted to the Postgraduate Institute of Medical Education and Research, Chandigarh over a period of three years were studied. All patients developed weakness of limbs within one day to three weeks. Attenuation of deep tendon jerks (98%) paresthesia (66%), cranial nerve involvement (41%) and antecedent infection (32%) were the common clinical features. The common patterns of motor weakness were predominantly proximal in all the four limbs (45%) or predominantly proximal in lower limbs along with distal muscles in upper limbs (29%). Electrodiagnostic studies revealed prolonged distal (motor) latency (82%), reduced motor nerve conduction velocity (74%), sensory nerve conduction abnormality (85%) and evidence of denervation (41%). Evoked motor response of median, ulnar, common peroneal and tibial nerves exhibited significant increase in duration and reduction in amplitude. The maximum incidence of electrophysiological abnormality occurred between four to 12 weeks after the onset of neurological symptoms. Four patients died and 11 showed poor recovery. Long intervals (greater than 3 weeks) between peak deficit and onset of recovery and coexistence of reduced motor nerve conduction velocity with evidence of denervation on EMG were found to be associated with poor recovery.
Assuntos
Polirradiculoneuropatia/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Eletrodiagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios Motores/fisiologia , Condução Nervosa , Polirradiculoneuropatia/metabolismo , Sensação/fisiologiaRESUMO
The arteriographic pattern of left hand vessels was studied in 20 patients in leprosy by percutaneous brachial arteriography. Arteriographic abnormalities noted consisted of occlusion, narrowing, tortuosity, dilatation, irregularity and incomplete filling of the lumen by contrast medium. Such abnormal findings were seen in all the arteriograms studied and more than one vessel involvement was noted in over 50 percent cases. This study clearly demonstrated that arterial involvement in leprosy was frequent. No correlation was found between motor weakness and vascular abnormalities. There was no difference in arterial lesions between the patients with and without trophic changes. There was also no correlation between the severity of vascular changes and decline in motor nerve conduction. Degree of histopathological abnormalities in the sural nerve biopsy from these patients showed no features of micro angiopathic neuropathy. It is concluded that the observed vascular abnormalities do not contribute significantly in the genesis of neurological deficit in leprosy.
Assuntos
Hanseníase/complicações , Neurite (Inflamação)/etiologia , Nervos Espinhais/patologia , Nervo Sural/patologia , Doenças Vasculares/etiologia , Adulto , Angiografia , Artéria Braquial/diagnóstico por imagem , Feminino , Humanos , Masculino , Condução Nervosa , Neurite (Inflamação)/fisiopatologia , Nervo Ulnar/fisiopatologia , Doenças Vasculares/fisiopatologiaRESUMO
The arteriographic pattern of left hand vessels was studied in 20 patients in leprosy by percutaneous brachial arteriography. Arteriographic abnormalities noted consisted of occlusion, narrowing, tortuosity, dilatation, irregularity and incomplete filling of the lumen by contrast medium. Such abnormal findings were seen in all the arteriograms studied and more than one vessel involvement was noted in over 50 percent cases. This study clearly demonstrated that arterial involvement in leprosy was frequent. No correlation was found between motor weakness and vascular abnormalities. There was no difference in arterial lesions between the patients with and without trophic changes. There was also no correlation between the severity of vascular changes and decline in motor nerve conduction. Degree of histopathological abnormalities in the sural nerve biopsy from these patients showed no features of micro angiopathic neuropathy. It is concluded that the observed vascular abnormalities do not contribute significantly in the genesis of neurological deficit in leprosy.
Assuntos
Masculino , Feminino , Humanos , Adulto , Condução Nervosa , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia , Hanseníase/complicações , Nervo Sural/patologia , Nervo Ulnar/fisiopatologia , Nervos Espinhais/patologia , Neuritos/etiologia , Neuritos/fisiopatologiaRESUMO
A case of trigeminal trophic syndrome presenting with painless ulceration of the scalp following herpes zoster ophthalmicus is presented. The pathogenesis of neurotrophic changes in the trigeminal territory is reviewed.
RESUMO
Responses to various tests of cardiovascular reflexes were studied in 15 patients with leprosy. Heart rate was continuously monitored by electrocardiogram and blood pressure was recorded simultaneously. Three patients showed evidence of cardiac dysautonomia, showing involvement of both the sympathetic and parasympathetic systems. These three patients belonged to the bacilliferous group.