ABSTRACT
Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.
Subject(s)
Leprosy, Paucibacillary/complications , Neuritis/surgery , Adolescent , Humans , Male , Nerve Block , Neuritis/etiology , Treatment OutcomeABSTRACT
Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.
Subject(s)
Adolescent , Humans , Male , Leprosy, Paucibacillary/complications , Neuritis/surgery , Nerve Block , Neuritis/etiology , Treatment OutcomeABSTRACT
PURPOSE: Only leprosy resource centres undertake surgery for neuritis. Patients' accessibility to this surgical procedure is poor because these centres are often far from their homes. The aim of our work is to study the feasibility of neuritis surgery in the field. METHODS: A surgeon trained in this surgery was recruited by Bom-Pastor hospital in Brazilian Amazonia, which is located 400 km away from the leprosy resource centre. Patients operated from May 1996 to December 1997 were enrolled in this retrospective study. RESULTS: A total of 45 operations were carried out during 17 procedures on 13 patients, among which 12 were multibacillary cases. The decompression surgery was performed with a median delay of 1 year after leprosy diagnosis and 3.5 months after the neuritis diagnosis. Among 17 operations, 14 were performed for painful neuritis of recent onset unsuccessfully treated with corticoids or recurring during the month after corticoids were withdrawn. The other three operations were performed for long-standing neuritis with paralysis and deformity. Pain was relieved in all the cases of recent neuritis, except for one patient who suffered from a serious steroid-dependant erythema nodosum leprosum. An improvement of motor function was observed in one out of three patients with long-standing neuritis. Adverse effects were few: a scar infection with a rapid recovery and a keloid scar. Two neurites recurred 2 and 10 months after the surgery. CONCLUSIONS: In an endemic leprosy region, field access to surgery for neuritis appears to prove real progress in the management of leprosy neuritis.
Subject(s)
Leprosy/surgery , Neuritis/surgery , Adolescent , Adult , Anti-Inflammatory Agents/therapeutic use , Brazil , Female , Follow-Up Studies , Humans , Leprosy/complications , Leprosy, Borderline/complications , Leprosy, Borderline/surgery , Leprosy, Lepromatous/complications , Leprosy, Lepromatous/surgery , Male , Middle Aged , Neuritis/drug therapy , Neuritis/etiology , Prednisone/therapeutic use , Recurrence , Time FactorsABSTRACT
Os autores apresentam um caso de neurite ciática hipertrófica hanseniana associada a neuroma de amputaçao. Nesta enfermidade, o envolvimento do nervo ciático e a formaçao de neuroma sao incomuns.
Subject(s)
Humans , Male , Aged , Amputation Stumps/surgery , Leprosy/surgery , Sciatic Nerve/surgery , Neuritis/surgery , Neuroma/surgery , Perna/surgeryABSTRACT
Um grupo de 33 pacientes de hanseníase apresentando neurite do nervo ulnar foram submetidos a neurolise com transposiçao anterior sub-cutânea deste nervo. A cirurgia foi indicada devido à progressiva piora da funçao neural mesmo com tratamento clínico. O teste com monofilamentos de Semme-Weinstein e avaliaçao de força motora foram utilizados para avaliar os pacientes antes e 12 meses após a cirurgia, 39,3 por cento apresentaram melhora, 39,3 por cento permaneceram estáveis e 21,4 por cento apresentaram piora da funçao neural.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Leprosy/surgery , Neuritis/surgery , Surgical Procedures, Operative , Ulnar Nerve/surgery , Leprosy, Borderline/surgery , Leprosy, Tuberculoid/surgeryABSTRACT
Los autores analizan los problemas del tratamiento quirúrgico de las neuritis hansenianas. Se establecen los criterios que deben ser utilizados. Ubican la cirugía en el contexto terapéutico. Presentan ejemplos de su casuística. Se sugiere uniformar los criterios a fin de tornar comparativos los resultados
Subject(s)
Humans , Leprosy/surgery , Leprosy/complications , Neuritis/surgery , Neuritis/diagnosis , Ulnar Nerve/injuries , Median Nerve/injuries , Tibial Nerve/injuries , ElectromyographyABSTRACT
Los autores analizan los problemas del tratamiento quirúrgico de las neuritis hansenianas. Se establecen los criterios que deben ser utilizados. Ubican la cirugía en el contexto terapéutico. Presentan ejemplos de su casuística. Se sugiere uniformar los criterios a fin de tornar comparativos los resultados
Subject(s)
Humans , Leprosy/surgery , Tibial Nerve/injuries , Ulnar Nerve/injuries , Leprosy/complications , Median Nerve/injuries , Neuritis/surgery , Neuritis/diagnosis , ElectromyographyABSTRACT
O autor apresenta uma técnica cirúrgica alternativa para tratamento da neurite hipertrófica hanseniana ulnar, que consiste na transposiçäo do segmento hipertrofiado do nervo para plano muscular profundo, sob o biceps, associando, a este procedimento, a epineurotomia e a técnica cirúrgica proposta por Learmonth