The spectrum of central nervous system manifestations in leprosy: a systematic review of published case reports and case series.

BACKGROUND: This systematic review aimed to investigate central nervous system (CNS) involvement in leprosy by analysing multiple cohort studies, individual cases and case series. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed, Scopus and Embase databases were searched up to 8 July 2023, using a predefined search strategy. Inclusion criteria included patients diagnosed with leprosy with evidence of CNS involvement. The quality of the included cases was evaluated using the Joanna Briggs Institute checklist. RESULTS: A total of 34 records were identified, including 18 cohort studies and 16 reports describing 27 isolated cases. Autopsies revealed macroscopic changes in the spinal cord, neurofibrillary tangles and senile plaques. Mycobacterium leprae was detected in neurons of the medulla oblongata and spinal cord using PCR and phenolic glycolipid 1 staining. Cerebrospinal fluid (CSF) analysis showed inflammatory changes, increased gamma globulins and detection of Mycobacterium leprae antigens and antibodies. In 21 patients (78%), spinal cord/brachial plexus abnormities were detected. In the majority, MRI revealed T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity in the cervical cord. In patients with brainstem involvement, T2/FLAIR hyperintensity was noted in the cerebellar peduncles, facial nerve nuclei and/or other cranial nerve nuclei. Brain parenchymal involvement was noted in three patients. CONCLUSIONS: This systematic review provides evidence of CNS involvement in leprosy, based on autopsy findings, neuroimaging, CSF analysis and neurophysiological studies.

Neural complications and physical disabilities in leprosy in a capital of northeastern Brazil with high endemicity / Complicações neurais e incapacidades em hanseníase em capital do nordeste brasileiro com alta endemicidade

INTRODUCTION: Leprosy is an infectious disease whose etiologic agent is Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms. OBJECTIVE: To investigate neural changes and the degree of physical disability in the eyes, hands and feet before and after treatment, as well as sociodemographic and clinical profile of patients affected by leprosy. METHOD: A longitudinal epidemiological study comprising 155 patients with leprosy, from a spontaneous demand, diagnosed between March 2010 and February 2011, and treated with multidrug therapy (MDT) between March 2010 and July 2012 in a program for leprosy eradication in São Luis (MA), Brazil. RESULTS: Before treatment, 46.5% of patients were considered as borderline, 51.6% had some alteration in the eyes and 52.3% in the feet, and the radial nerve (18.7%) was the most affected. There was a statistically significant difference between the changes in the radial nerve at the beginning of and after treatment. CONCLUSIONS: The analysis points to late diagnosis, as some patients have had abnormal neural and physical disabilities before treatment. .

INTRODUÇÃO: A hanseníase é uma doença infectocontagiosa cujo agente etiológico é o Mycobacterium leprae, que se manifesta por sinais e sintomas dermatoneurológicos. OBJETIVO: investigar as complicações neurais e o grau de incapacidades físicas nos olhos, mãos e pés antes e após o tratamento, bem como o perfil sociodemográfico e clínico dos pacientes acometidos pela hanseníase. MÉTODO: Estudo epidemiológico do tipo longitudinal constituído por 155 pacientes com hanseníase, a partir da demanda espontânea, diagnosticados no período de março de 2010 a fevereiro de 2011 e tratados com poliquimioterapia (PQT) entre março de 2010 a julho de 2012, em um programa de eliminação da hanseníase, no município de São Luís (MA). RESULTADOS: Antes do tratamento, 46,5% dos pacientes apresentaram forma dimorfa, 51,6% possuíam alguma alteração nos olhos e 52,3% nos pés, sendo o nervo radial (18,7%) o mais acometido. Houve diferença estatisticamente significante entre as complicações do nervo radial no inicio e após o tratamento. CONCLUSÕES: Evidenciou-se a presença do diagnóstico tardio, posto que alguns pacientes já apresentavam complicações neurais e incapacidades físicas antes do tratamento. .

Neural complications and physical disabilities in leprosy in a capital of northeastern Brazil with high endemicity.

INTRODUCTION: Leprosy is an infectious disease whose etiologic agent is Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms. OBJECTIVE: To investigate neural changes and the degree of physical disability in the eyes, hands and feet before and after treatment, as well as sociodemographic and clinical profile of patients affected by leprosy. METHOD: A longitudinal epidemiological study comprising 155 patients with leprosy, from a spontaneous demand, diagnosed between March 2010 and February 2011, and treated with multidrug therapy (MDT) between March 2010 and July 2012 in a program for leprosy eradication in São Luis (MA), Brazil. RESULTS: Before treatment, 46.5% of patients were considered as borderline, 51.6% had some alteration in the eyes and 52.3% in the feet, and the radial nerve (18.7%) was the most affected. There was a statistically significant difference between the changes in the radial nerve at the beginning of and after treatment. CONCLUSIONS: The analysis points to late diagnosis, as some patients have had abnormal neural and physical disabilities before treatment.

The immune reconstitution inflammatory syndrome in whipple disease: a cohort study.

BACKGROUND: Whipple disease, which is caused by infection with Tropheryma whipplei, can be treated effectively with antimicrobials. Occasionally, inflammation reappears after initial improvement; this is often interpreted as refractory or recurrent disease. However, polymerase chain reaction for T. whipplei in tissue is sometimes negative during reinflammation, indicating absence of vital bacteria, and this reinflammation does not respond to antimicrobials but does respond to steroids. OBJECTIVE: To demonstrate that the immune reconstitution inflammatory syndrome (IRIS) occurs in patients treated for Whipple disease. DESIGN: Cohort study. (International Standard Randomised Controlled Trial Number Register registration number: ISRCTN45658456) SETTING: 2 academic medical centers in Germany. METHODS: 142 patients treated for Whipple disease out of a cohort of 187 were observed for reappearance of inflammatory signs after effective antibiotic therapy. Definitions of IRIS in HIV infection, tuberculosis, and leprosy were adapted for application to Whipple disease. RESULTS: On the basis of study definitions, IRIS was diagnosed in 15 of 142 patients. Symptoms included fever, arthritis, pleurisy, erythema nodosum, inflammatory orbitopathy, small-bowel perforation, and a hypothalamic syndrome. Two patients died. There was a positive correlation with previous immunosuppressive treatment and a negative correlation with previous diarrhea and weight loss. LIMITATIONS: The study was observational and thus has inherent weaknesses, such as incomplete and potentially selective data recording. CONCLUSION: The immune reconstitution inflammatory syndrome was diagnosed in about 10% of patients with Whipple disease in the study cohort; the outcome varied from mild to fatal. Patients who had had previous immunosuppressive therapy were at particular risk. An immune reconstitution syndrome should be considered in patients with Whipple disease in whom inflammatory symptoms recur after effective treatment. Early diagnosis and treatment with steroids may be beneficial; prospective studies are needed. PRIMARY FUNDING SOURCE: European Commission and Deutsche Forschungsgemeinschaft.

Itraconazole and fluconazole in three neuro-paracoccidioidomycosis patients / Itraconazol e fluconazol em 3 pacientes com neuro-paracoccidioidomicose (PBM) cerebral

Three paracoccidioidomycoses (OBM) patients: Male, age 44,51 and 53 years old, form workers, heavy smokers, alcoholics were admitted in to Emílio Ribas Hospital, Såo Paulo, SP, with dyspnea, expectorative cough in all of them and evolutive cardiac edema in two C.O.P.D. inpatients. Hypertensive / nephropathy - 2, adenopathy - 2, clubbing finger, Cor pulmonale (C.O.P.D.), hepatoesplenomegaly and severe interstitial bilateral infiltrate lung lesions were related in 2 patients. Encephalopaty and cerebelar ataxia in one, focal convulsive crises, hypoastesia right arm and Mingazzini neurologic examens were observed in two patients. Paracoccidioides brasiliensis was recovered from bronchoscopy. Pulmonary function showed: bronchodilator no response and 2 mixels test, hypergamaglobulinemia, increases seric level alcaline phosphatase in 3, policytemia in 2 and complement fixation reaction rancing from 1/8 to 1/64 with negative counter immunoelectrophoresis, like laboratorial examens. Berebral C.T. -scan confirmed active nodules in three and cerebelar abscess in one. Azoles therapy revealed one early deth and after 18 months the presence of active nocules (C.T.-scan skull) in 2 of all chronic lung PBM patients

Un neurologo en el bosque / A neurologist in the forest

Para los que ya están formados y los que vendrán, las páginas que hoy presento en la esperanza de brindar por un lado ejemplos, episodios, anécdotas y por el otro enseñanzas que considero serán de utilidad. Se injertan en estas páginas conceptos teóricos y prácticos que están escritos algunos en textos de neurología, pero algunos no lo están por ser producto personal, resultado de la observación, de la intuición del médico, de las comparaciones. No pretendo ser completo sino simplemente quiero trasladar al papel ejemplos de curiosidades médicas, salpicado de comentarios diversos conducentes a contribuir con un granito de arena al conocimiento. Si vuestro tiempo gastado en la lectura, llega a ser, aunque más no sea una distracción pasajera, matizado de algún agregado al conocimiento, me sentiré satisfecho. Un cuadro psiquiátrico. Psicosis esquizofrénica. Crisis hipertensiva?. Parálisis general progresiva P.G.P. Dorsalgia y psicosis. Cefalea postraumática. Sinusitis. Cefalalgia por sinusitis: oxigenoterapia. Depresión reactiva. Arteriosclerosis cerebral?. Crisis convulsivas. Alucinaciones visuales. Psicosis progresiva. Cáncer terminal de origen desconocido. El paciente de Pavlov. Poliomielitis. Miastenia. Miscelaneas entre páginas (ref. fotomotor, midriasis, Claude Bernard Horner versus III par. Síndrome de las Tres A). Paraplejía aguda por arma de fuego. Síndrome de insuficiencia vertebral versus tumor cerebeloso. Reflejo radial. Variante. Sección del crural por arma blanca. El reflejo plantar patológico: Babinsky. Hematoma epidural. Notas del T. E. C. Miscelanea (lepra). El signo de la rueda dentada de Negro. Coma (curiosidades). Coma traumático con recuperación postquirúrgica incompleta. Raro diagnóstico. Cual es el turno siguiente?. Anticonceptivos. Anticonvulsivos. Uso discriminado. Líquido cefaloraquídeo. Miscelaneas (disfonia, insólito). Amaurosis bilateral. Amor propio y dignidad. Manuel de Falla. Paraplejía aguda

Un neurologo en el bosque / A neurologist in the forest

Para los que ya están formados y los que vendrán, las páginas que hoy presento en la esperanza de brindar por un lado ejemplos, episodios, anécdotas y por el otro enseñanzas que considero serán de utilidad. Se injertan en estas páginas conceptos teóricos y prácticos que están escritos algunos en textos de neurología, pero algunos no lo están por ser producto personal, resultado de la observación, de la intuición del médico, de las comparaciones. No pretendo ser completo sino simplemente quiero trasladar al papel ejemplos de curiosidades médicas, salpicado de comentarios diversos conducentes a contribuir con un granito de arena al conocimiento. Si vuestro tiempo gastado en la lectura, llega a ser, aunque más no sea una distracción pasajera, matizado de algún agregado al conocimiento, me sentiré satisfecho. Un cuadro psiquiátrico. Psicosis esquizofrénica. Crisis hipertensiva?. Parálisis general progresiva P.G.P. Dorsalgia y psicosis. Cefalea postraumática. Sinusitis. Cefalalgia por sinusitis: oxigenoterapia. Depresión reactiva. Arteriosclerosis cerebral?. Crisis convulsivas. Alucinaciones visuales. Psicosis progresiva. Cáncer terminal de origen desconocido. El paciente de Pavlov. Poliomielitis. Miastenia. Miscelaneas entre páginas (ref. fotomotor, midriasis, Claude Bernard Horner versus III par. Síndrome de las Tres A). Paraplejía aguda por arma de fuego. Síndrome de insuficiencia vertebral versus tumor cerebeloso. Reflejo radial. Variante. Sección del crural por arma blanca. El reflejo plantar patológico: Babinsky. Hematoma epidural. Notas del T. E. C. Miscelanea (lepra). El signo de la rueda dentada de Negro. Coma (curiosidades). Coma traumático con recuperación postquirúrgica incompleta. Raro diagnóstico. Cual es el turno siguiente?. Anticonceptivos. Anticonvulsivos. Uso discriminado. Líquido cefaloraquídeo. Miscelaneas (disfonia, insólito). Amaurosis bilateral. Amor propio y dignidad. Manuel de Falla. Paraplejía aguda

Infections and infestations of the central nervous system in India. A review.

Based on extensive personal experiences during the past three decades, a review is given on infections and infestations of the central nervous system, which are found in India and in other tropical and subtropical areas. Besides the main disease such as tuberculosis, pyogenic infections and parasitic infestations, rare lesions are also discussed. The literature has been cited in extenso and more especially the contributions by Indian neurosurgeons and neurologists.

[Study of afferent conduction in the external saphenous nerve using the method of evoked cerebral potentials]. / Etude de la conduction afférente dans le nerf saphène externe par le technique des potentiels évoqués cérébraux

By the comparison of nerve action potentials and cerebral potentials evoked by the same electrical stimulus the propagation of the somaesthetic impulse to the cerebral cortex can be evaluated. This technique was applied to the fibres of the sural nerve in normal subjects and in patients presenting various lesions of the peripheral and central nervous system. Evoked cerebral potential afforded valuable data when it was not possible to record the nerve action potentials or when the lesion involved the central segment of the afferent pathway.