ABSTRACT
Patients with leprosy may have only nerve involvement without skin changes. These cases are known as pure neural leprosy and can be seen in 10% of leprosy patients. Most patients have mononeuritic or multiple mononeuritic neuropathy patterns. The isolated lesion of the superficial peroneal nerve is uncommonly seen. We report a patient with involvement of this nerve in which there was no thickening of superficial nerves. The performed nerve biopsy showed inflammatory infiltration, loss of fibers and presence of Mycobacterium leprae. We believe that in prevalent leprosy countries we should take in mind the possibility of isolated pure neural leprosy in some patients without skin lesion. In these cases the diagnosis of leprosy is impossible on clinical grounds and nerve biopsy is mandatory.
Subject(s)
Leprosy, Tuberculoid/pathology , Peroneal Neuropathies/pathology , Female , Humans , Middle Aged , Peroneal Nerve/pathologyABSTRACT
Em alguns casos de lepra podemos encontrar acometimento de nervos periféricos sem manifestações cutâneas. É a denominada lepra neurítica pura que pode ocorrer em até 10% dos casos desta doença. Na maioria das vezes predominam quadros de mononeuropatia ou mononeuropatia múltipla. O acometimento isolado do nervo peroneiro superficial tem sido pouco relatado. Referimos a uma paciente com acometimento isolado deste nervo sem hipertrofia de troncos nervosos. A biópsia realizada mostrou presença de infiltrado inflamatório, perda moderada de fibras e presença do Mycobacterium leprae. Acreditamos que, em países onde a lepra é endêmica, diante de acometimento isolado de nervos periféricos, deve-se pensar na possibilidade de se tratar da forma neurítica pura desta moléstia, mesmo em pacientes sem alterações dermatológicas. Nestes casos o diagnóstico só será possível com a realização de biópsia de nervo superficial.
Subject(s)
Humans , Female , Middle Aged , Leprosy, Tuberculoid/pathology , Peroneal Neuropathies/pathology , Peroneal Nerve/pathologyABSTRACT
Leprosy is one of the most common diseases of the peripheral nerves. In some cases there is only neural involvement without skin changes (neuritic form). The neuropathy has often a distal stocking and glove distribution with thermal and pinprick anesthesia and preservation of proprioception. There is no weakness, the tendon reflexes may be preserved and sometimes the nerves are thickened. We reported 17 patients with a predominantly small-fiber polyneuropathy due to leprosy. All patients had distal temperature and pain anesthesia with different individual variations. The tendon reflexes were normal in seven patients and in eight there was thickening of the nerves. The nerve conduction was normal in three patients. Sural nerve biopsy consisted of: 1) inflammatory infiltrates, 2) vacuolated "foamy" cells, 3) fibrosis of endoneurium, perineurium, and epineurium, 4) partial or total loss of nerve fibers, 5) large number of bacilli. We concluded that in countries where leprosy is frequent, nerve biopsy is an obligatory procedure in patients with predominantly small-fiber polyneuropathy.
Subject(s)
Leprosy/pathology , Neuritis/pathology , Peripheral Nerves/pathology , Polyneuropathies/pathology , Adult , Aged , Aged, 80 and over , Biopsy , Female , Humans , Leprosy/microbiology , Male , Middle Aged , Neural Conduction , Neuritis/microbiologyABSTRACT
Leprosy is one of the most common diseases of the peripheral nerves. In some cases there is only neural involvement without skin changes (neuritic form). The neuropathy has often a distal stocking and glove distribution with thermal and pinprick anesthesia and preservation of proprioception. There is no weakness, the tendon reflexes may be preserved and sometimes the nerves are thickened. We reported 17 patients with a predominantly small-fiber polyneuropathy due to leprosy. All patients had distal temperature and pain anesthesia with different individual variations. The tendon reflexes were normal in seven patients and in eight there was thickening of the nerves. The nerve conduction was normal in three patients. Sural nerve biopsy consisted of: 1) inflammatory infiltrates, 2) vacuolated "foamy" cells, 3) fibrosis of endoneurium, perineurium, and epineurium, 4) partial or total loss of nerve fibers, 5) large number of bacilli. We concluded that in countries where leprosy is frequent, nerve biopsy is an obligatory procedure in patients with predominantly small-fiber polyneuropathy
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Leprosy , Neuritis , Peripheral Nerves , Polyneuropathies , Biopsy , Leprosy , Neural Conduction , Neuritis , Peripheral NervesABSTRACT
A lepra constitui causa frequente de acometimento de nervos periféricos, em nosso meio. O sistema nervoso periférico é acometido por vezes sem que haja alteraçoes cutâneas: é a chamada forma neurítica pura. Nessa variante, o nervo mais afetado é o ulnar. Nos casos de acometimento isolado de nervos periféricos somente a feitura de biópsia de nervo conduzirá ao diagnóstico. Assim, resolvemos realizar biópsia do ramo sensitivo superficial do nervo ulnar na mao em 17 pacientes com paresia ou paralisia desse nervo e espessamento do mesmo na altura do cotovelo. Os pricnipais achados foram: reduçao do número de fibras mielínicas em 14 casos, infiltrado inflamatório em 13, fibrose em 12, desmielinizaçao e remielinizaçao em 9, presença de granuloma em 6 e visualizaçao do Mycobacterium leprae em 5. Concluímos que a biópsia do ramo sensitivo superficial do nervo ulnar na mao é um bom meio diagnóstico de lepra em pacientes com acometimento desse nervo.
Subject(s)
Adult , Middle Aged , Female , Humans , Adolescent , Biopsy , Hand/innervation , Leprosy, Tuberculoid/pathology , Paralysis/pathology , Peripheral Nervous System Diseases/pathology , Ulnar Nerve/pathology , Leprosy, Tuberculoid/complications , Leprosy, Tuberculoid/diagnosis , Paralysis/etiology , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/etiologySubject(s)
Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/pathology , Leprosy, Tuberculoid/complications , Leprosy, Tuberculoid/pathology , Monoamine Oxidase/anatomy & histology , Monoamine Oxidase/innervation , Ulnar Nerve/pathology , Paralysis/etiology , Paralysis/pathologyABSTRACT
A hipertrofia da panturrilha no curso de ciática é raramente observada. É relatado o caso de uma paciente com 28 anos de idade que apresentou episódios repetidos de dor lombar irradiada para nádega e pé esquerdos. Um ano após o início dos sintomas, notou aumento da panturrilha esquerda. Estudos radiográficos revelaram degeneraçäo do disco de L5-S. O exame eletromiográfico mostrou desnervaçäo muscular com velocidade de conduçäo motora normal. Foram realizadas biópsias dos músculos gastrocnêmios. No esquerdo notou-se hipertrofia das fibras tipo 2, em comparaçäo ao gastrocnêmio direito. A microscopia eletrônica revelou aumento do número de mitocôndrias nas fibras hipertrofiadas. Explicaçäo satisfatória para a hipertrofia muscular na vigência de desnervaçäo ainda näo foi definida