Neuroimaging in leprosy: The nerves and beyond

Pragmatic guide to peripheral nerve disease and the role of clinical biomarkers

“…Imaging of peripheral nerves with MRI and ultrasound scanning has been explored for over 20 years52 53 and has entered diagnostic guidelines 54 55. Nerve thickening and signal abnormality are present in a variety of genetic56 and acquired57 58 neuropathies, including CIDP57 and acute inflammatory demyelinating polyneuropathy,58 MMNCB,59 POEMS60 and neurolymphomatosis,61 infective neuropathies (especially leprosy)62 and rarely sarcoidosis 63…”

Imaging of Nerve Disorders in the Elbow

“…Calcified neural granulomas and microabscesses may be seen in more chronic and advanced cases. 62 COVID-19 may even manifest as a postinfectious inflammatory neuropathy. In particular, chronically bedbound patients with COVID-19 may develop positioning-related neuropathies and extrinsic compressive neuropathies, with the latter associated with subcutaneous and intramuscular hematomas, especially at the initiation of or in the setting of a poorly controlled anticoagulation regimen.…”

Brachial plexopathy with ulnar nerve abscess in leprosy: A case showing importance of magnetic resonance neurography with clinical, imaging and histopathological correlation

“…4 Brachial plexus involvement in leprosy and its magnetic resonance neurography appearance has been rarely described in the literature. 5 Magnetic resonance neurography is indispensable in the evaluation of brachial plexus and peripheral nerves. It allows fine detailed evaluation of nerve anatomy and pathology, internal architecture, course, caliber and involvement of regional muscles.…”

“…Awareness of MRI findings in leprosy including brachial plexus involvement becomes more important in the current scenario wherein the pure neuritic form of leprosy is frequently encountered, helping in early detection, effective management and prevention of nerve damage. 5 It has been observed that brachial plexus involvement is commonly seen in the borderline tuberculoid variant of leprosy. 5 This may be because of the fact that cases towards the tuberculoid end of the spectrum mount a better cell-mediated immune response leading to the formation of epithelioid granulomas and perineural fibrosis manifested on imaging as nerve thickening.…”

“…5 It has been observed that brachial plexus involvement is commonly seen in the borderline tuberculoid variant of leprosy. 5 This may be because of the fact that cases towards the tuberculoid end of the spectrum mount a better cell-mediated immune response leading to the formation of epithelioid granulomas and perineural fibrosis manifested on imaging as nerve thickening. Thus, long term management of brachial plexopathy due to leprosy, in this case, will depend on the inflammatory process triggered by Mycobacterium leprae.…”