[A rare cause of carpal tunnel syndrome: leprosy. Latency period of decades is possible]. / Seltene Ursache eines Karpaltunnelsyndroms: Lepra. Jahrzehntelange Latenzzeit möglich.

In a 63-year-old German woman with no apparent exposure to leprosy, clinical and histological evidence of tuberculoid leprosy was found. A noteworthy feature of this case is either the very long incubation time of 45 years, or the mode of infection involving an only short encounter in an endemic region. In the event of unclear lesions--on white skin not, typically, hypopigmented, but reddish--accompanied by disordered sensation, we in Europe must also give consideration to the possibility of a sporadic case of leprosy. A particular characteristic of this case was leprous neuritis involving the median nerve which was diagnosed clinically as carpal tunnel syndrome, and scheduled for surgical treatment. Under treatment with dapsone and rifampicin, however, the condition cleared up completely.

Imaging of peripheral nerve lesions.

The imaging of peripheral nerve lesions remains limited to the radiographic demonstration of secondary skeletal lesions in birth trauma, reflex sympathetic dystrophy, neuropathic arthropathy, leprosy, and congenital indifference to pain. Nerve root avulsions can be imaged directly and the newer imaging modalities now allow delineation of lesions that previously could not be studied using conventional radiography. The ability of ultrasound, CT, and MRI to differentiate soft tissue structures makes it possible, in many instances, to study the primary abnormality in trauma, nerve entrapment syndromes, and tumors. With fractures, the possibility of trauma to adjacent nerves can only be inferred on the radiographs, while the role that peripheral nerve injury plays remains controversial in other entities, such as amputation with replantation. Imaging of peripheral nerve lesions remains in its infancy. With further refinement in the signal-to-noise ratio made possible by advances in MRI technology, we may be optimistic about future imaging of peripheral nerve pathology.