Pure Neuritic Hansen in patients presenting with Peripheral Neuropathy: A Clinicohistopathological study

Rajesh, R (2011) Pure Neuritic Hansen in patients presenting with Peripheral Neuropathy: A Clinicohistopathological study. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Leprosy is one of the oldest diseases; endemic in India and of social concern as its complications leads to social stigma and decreased quality of life. Its long incubation period makes it completely difficult to diagnose early and its chronic course decreases the compliance of the patient towards the treatment. Leprosy is the most common treatable cause of neuropathy. The schwann cells of nerves are the first to be involved in leprosy. Leprosy is considered important primarily because of its potential to cause permanent and progressive physical deformities with serious social and economic consequences1. In all forms of leprosy atleast one peripheral nerve is invaded by M. leprae, though this may not be clinically evident. One of the primary complications of Leprosy is damage to peripheral nerves, which may be irreversible if not diagnosed and treated early. Leprosy, however can involve nerves without any skin changes2. Pure Neuritic Leprosy is a well accepted clinical entity. In the absence of skin lesions there is a greater possibility of missing the diagnosis of leprosy particularly due to a wide variety of pure neural manifestations that may mimic other peripheral neuropathies6. Classification of pure neuritic leprosy poses problems since the histological spectrum (e.g. Ridley-Jopling scale) is based chiefly on the skin findings. Review of the past literature shows conflicting reports about comparability of the skin and nerve findings3. Further the Pure Neuritic type is thought to be more common in countries endemic for Leprosy, particularly India. Hence this study tries to find out the prevalence and describes purely neuritic leprosy and its characteristics and the need for diagnosing it early. AIM OF THE STUDY : 1. To find the Age group distribution of Pure Neuritic Leprosy. 2. Gender characteristic patterns of Pure Neurtic Hansen. 3. Geographical distribution of Pure Neuritic Hansen 4. Occupational incidence among patients with Pure Neuritic Hansen 5. Clinical presentations of Pure Neuritic Hansen. 6. Pattern of nerve involvement. 7. Deformities associated with Pure Neuritic Hansen. 8. Electrophysiological Pattern of Pure Neuritic Hansen. 9. Histopathological changes in the Nerve associated with Pure Neuritic Hansen. CONCLUSION : The Commonest Age group of occurrence is 25-35 years, though actual Age of onset of PNL is 15-25 years. * Males predominates Females with a Male to Female Sex Ratio of 2.75:1 * PNL presents with more than one symptom, and the most common manifestation of PNL is Sensory impairment, especially hypoesthesia. * Ulnar Nerve is the most common nerve trunk involved in PNL and Radial Cutaneous Nerve is the most common cutaneous nerve to get thickened. Bilateral thickening is more common. * Pure Sensory involvement is more common, both sensory and motor involvement can occur, but pure motor involvement is very rare. * Mononeuropathy is most common in PNL, though PNL can present as Mononeuritis Multiplex, polyneuropathy is very rare. * Claw Hand is the most common Paralytic Deformity. In lower limb, Foot drop is more common. * Trophic Ulcers of foot are the most common Anaesthetic Deformity. Autoamputation and Resorption can occur in PNL. * PNL most commonly presents with Grade 2 disability and is a major health concern as it is associated with severe social dependence and morbidity. * Nerve conduction is an important Screening tool for PNL, but has limited use in very early and localised disease. * All histological types of Leprosy can be demonstrated in PNL, but Tuberculoid is the most common and Lepromatous Leprosy may occur very rarely. * AFB may be negative in Nerve biopsy, especially in Tuberculoid spectrum. * Skin Biopsy in PNL has limited use alone though it may be an adjunct for Nerve biopsy in cases with sensory altered skin. * Nerve biopsy is the gold standard in diagnosis of PNL, though it may miss very early stage of PNL and further detailed histopathological studies are needed. * Pure Neuritic Hansen can be an initial stage of Leprosy, which may manifest later in life. * Though Relapse is uncommon, Multi Drug Therapy based on clinical signs alone may lead to inadequate therapy and increased risk of Relapse as the PNL can histopathologically present as any spectrum of Leprosy. * In endemic country like India, further larger studies are needed for early diagnosis and treatment of PNL, and thus preventing serious deformities and morbidity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pure Neuritic Hansen ; patients ; peripheral neuropathy ; clinicohistopathological study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Jul 2017 06:18
Last Modified: 01 Mar 2018 16:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/1000

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