Coexistence of Nerve Enlargement and Neuratrophy Detected by Ultrasonography in Leprosy Patients

Abstract

The purpose of this study was to evaluate peripheral neural impairment in leprosy patients by ultrasonography (US). The cross-sectional areas (CSAs) of the median (M), ulnar (U) and common fibular (CF) nerves were compared in 71 leprosy patients and 29 healthy controls, and the data were analyzed between the leprosy, multibacillary (MB)/paucibacillary (PB), reaction (R)/no reaction (NR), disability (D)/no disability (ND), and longer/shorter duration groups after treatment. We found that for the nerves located in upper limbs, the CSAs were significantly increased in the leprosy patients vs the controls; the PB group vs the MB group; the R group vs the NR group; the ND group vs the D group; and the longer duration group vs the shorter duration group at some positions of the M nerve and U nerve. In contrast, for the nerves located in lower limbs, the CSAs were significantly reduced in the leprosy patients vs the controls and in the longer duration group vs the shorter duration group at some positions of the CF nerve. This result indicated that nerve enlargement and neuratrophy coexist in leprosy patients.

Sonographic pattern of median nerve enlargement in Hansen's neuropathy

“…In another study, the mean CSA of the median nerve was 14.7 ± 11.6 mm 2 2 . In a study by Chen et al, 17 a combination of enlarged CSA of nerves in the upper limbs and atrophy of lower limb nerves was noted. While one study reported increased CSA in paucibacillary as compared to multibacillary leprosy, another study reported the contrary 3,17 .…”

“…In a study by Chen et al, 17 a combination of enlarged CSA of nerves in the upper limbs and atrophy of lower limb nerves was noted. While one study reported increased CSA in paucibacillary as compared to multibacillary leprosy, another study reported the contrary 3,17 . Nerve enlargement has been reported to be more pronounced among those in reaction and longer disease duration 17,20 .…”

“…While one study reported increased CSA in paucibacillary as compared to multibacillary leprosy, another study reported the contrary 3,17 . Nerve enlargement has been reported to be more pronounced among those in reaction and longer disease duration 17,20 . It may be noted that normative data drawn from the general population have shown that the CSA of the median nerve is larger in men as compared to women 21,22 .…”

“…Frade et al 15 recorded the median nerve CSA at a single anatomical point, that is, 5‐cm proximal to the wrist crease. Other studies recorded the sonological characteristics of the median nerve at the wrist with or without recording from the middle and distal one‐third of the forearm 3,16,17 …”

Neurological Complications of Leprosy

“…The authors suggest that nerve enlargement and atrophy may coexist in the pathophysiology of neuropathy associated with leprosy. 68 Another group found that the magnitude of nerve thickening is greater in MB and in patients with reactions. 69 A prospective case-control study evaluated the ulnar nerves of 48 patients diagnosed with leprosy at three locations close to the elbow, compared with 60 clinically normal ulnar nerves.…”