Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

Reddy, Y Muralidhar; Murthy, J. M. K.; Pidaparthi, Lalitha; Jaiswal, Shyam K; Kiran, E. S. S.; Penneru, Anusha; Nukala, Ravi; Kumar, S. Ramesh Chandra

doi:10.47276/lr.92.3.207

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Our sample consisted of 53 individuals, assessed in detail by a radiologist with experience in the evaluation of peripheral nerves. Although there was no pairing specifically for this study, the data obtained in this group are in accordance with the normality standards used in other studies [ 28 , 30 , 33 ].…”

Section: Methodssupporting

confidence: 84%

“…There were statistically significant differences in ΔUtpt and ΔTtpt values, with higher measurements observed a few centimeters above the tunnel level. Although the median nerve did not differ statistically between the tunnel and pre-tunnel points, thickened nerves were more numerous above the tunnel level [ 33 ]. Previous studies have shown that ΔUtpt possess high specificity for diagnosis of leprosy [ 21 , 22 , 38 ]; however, this is one of the first studies in which this finding was described for the tibial nerve.…”

Section: Discussionmentioning

confidence: 99%

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Role of multisegmental nerve ultrasound in the diagnosis of leprosy neuropathy

De Martino Luppi,

Ferreira,

Borges

et al. 2024

PLoS ONE

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Introduction/Aims Leprosy is the most common treatable peripheral neuropathy worldwide. The detection of peripheral nerve impairment is essential for its diagnosis and treatment, in order to prevent stigmatizing deformities and disabilities. This study was performed to identify neural thickening through multisegmental ultrasound (US). Methods We assessed US measurements of cross-sectional areas (CSAs) of ulnar, median and tibial nerves at two points (in the osteofibrous tunnel and proximal to the tunnel), and also of the common fibular nerve at the fibular head level in 53 leprosy patients (LP), and compared with those of 53 healthy volunteers (HV), as well as among different clinical forms of leprosy. Results US evaluation detected neural thickening in 71.1% (38/53) of LP and a mean number of 3.6 enlarged nerves per patient. The ulnar and tibial were the most frequently affected nerves. All nerves showed significantly higher measurements in LP compared with HV, and also greater asymmetry, with significantly higher values for ulnar and tibial nerves. We found significant CSAs differences between tunnel and pre-tunnel points for ulnar and tibial nerves, with maximum values proximal to the tunnel. All clinical forms of leprosy evaluated showed neural enlargement through US. Discussion Our findings support the role of multisegmental US as a useful method for diagnosing leprosy neuropathy, revealing that asymmetry, regional and non-uniform thickening are characteristics of the disease. Furthermore, we observed that neural involvement is common in different clinical forms of leprosy, reinforcing the importance of including US evaluation of peripheral nerves in the investigation of all leprosy patients.

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Section: Methodssupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Role of multisegmental nerve ultrasound in the diagnosis of leprosy neuropathy

De Martino Luppi,

Ferreira,

Borges

et al. 2024

PLoS ONE

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“…The HV group was evaluated in detail by a radiologist with experience in the evaluation of peripheral nerves and, although there was no pairing specifically for this study, the data obtained in this group are in accordance with the normality standards used in other studies [22,[30][31][32]. Considering that the US assessment of peripheral nerves is still a recent technique, we believe that internal standardization is important.…”

Section: Plos Onementioning

confidence: 71%

High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts

Luppi,

Ferreira,

Prudêncio

et al. 2023

PLoS ONE

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Leprosy household contacts (HC) represent a high-risk group for the development of the disease. Anti-PGL-I IgM seropositivity also increases the risk of illness. Despite significant advances in leprosy control, it remains a public health problem; and early diagnosis of this peripheral neuropathy represents one of the main goals of leprosy programs. The present study was performed to identify neural impairment in leprosy HC by analyzing differences in high-resolution ultrasonographic (US) measurements of peripheral nerves between leprosy HC and healthy volunteers (HV). Seventy-nine seropositive household contacts (SPHC) and 30 seronegative household contacts (SNHC) underwent dermato-neurological examination and molecular analysis, followed by high-resolution US evaluation of cross-sectional areas (CSAs) of the median, ulnar, common fibular and tibial nerves. In addition, 53 HV underwent similar US measurements. The US evaluation detected neural thickening in 26.5% (13/49) of the SPHC and only in 3.3% (1/30) among the SNHC (p = 0.0038). The CSA values of the common fibular and tibial nerves were significantly higher in SPHC. This group also had significantly greater asymmetry in the common fibular and tibial nerves (proximal to the tunnel). SPHC presented a 10.5-fold higher chance of neural impairment (p = 0.0311). On the contrary, the presence of at least one scar from the BCG vaccine conferred 5.2-fold greater protection against neural involvement detected by US (p = 0.0184). Our findings demonstrated a higher prevalence of neural thickening in SPHC and support the role of high-resolution US in the early diagnosis of leprosy neuropathy. The combination of positive anti-PGL-I serology and absence of a BCG scar can identify individuals with greater chances of developing leprosy neuropathy, who should be referred for US examination, reinforcing the importance of including serological and imaging methods in the epidemiological surveillance of leprosy HC.

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Median nerve impairment in leprosy: how does it differ from the classic carpal tunnel syndrome?

Alves,

Cirino,

Garcia

et al. 2024

Arq Neuropsiquiatr

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Background Carpal tunnel syndrome (CTS) has already been described as a possible form of neural leprosy presentation. However, the median nerve can be involved in this neuropathy in proximal segments and, sometimes, with an asymmetric impairment of the digital branches. Objective To detail the pattern of median nerve impairment through nerve conduction study (NCS) and ultrasound evaluation. Methods This cross-sectional study comprises 15 primary neural leprosy (PNL) patients and 14 patients with CTS who underwent peripheral nerve ultrasonography and NCS evaluation. Results From the total, 92.8% of patients with CTS and 80% with PNL had bilateral impairment of the median nerve, with 27 nerves in each group. Considering the cross-sectional area (CSA) of the tunnel (Mt) segment, 63% of the nerves in the CTS and 74.1% in the PNL groups were found to be thickened, with an average CSA of 13.4 ± 4.4 and 12.4 ± 4.6, respectively (p = 0.18). The CSA of the proximal tunnel (Mpt) segment showed thickening in only 3.7% in the CTS group and 96.3% in the PNL (p < 0.0001), with an average of 6.6 ± 1.3 and 17.0 ± 6.7, respectively (p < 0.001). Finally, 88.9% of the nerves in the PNL group and only 7.4% in the CSA (p < 0.0001) showed a reduction in conduction velocity in the distal forearm, with an average of 41.0 ± 6.3 and 53.2 ± 5.2, respectively (p < 0.0001). Conclusion The presence of neural thickening and demyelinating impairment in the segments proximal to the carpal tunnel favors the diagnosis of leprosy.

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Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

Cited by 4 publications

References 21 publications

Role of multisegmental nerve ultrasound in the diagnosis of leprosy neuropathy

Role of multisegmental nerve ultrasound in the diagnosis of leprosy neuropathy

High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts

Median nerve impairment in leprosy: how does it differ from the classic carpal tunnel syndrome?

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