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

Y Muralidhar Reddy,Shyam K Jaiswal,E S S Kiran,Ravi Nukala,Anusha Penneru,Jagarlapudi M K Murthy,Lalitha Pidaparthi,Sudhir Kumar

doi:10.47276/lr.92.3.207

Abstract

Background and objectives High-resolution ultrasonography (HRUS) has become a vital imaging tool in the management of leprosy. This case-control study analyzed the sonographic data on median nerves in leprosy and healthy controls to identify the features characteristic of leprosy. Methods Newly diagnosed and treatment naïve Hansen’s patients of both sexes and aged >16 years were included in the study. The control group included prospectively enrolled healthy subjects. Nerve conduction studies were performed in all. HRUS of the median nerve was performed using a Philips HD15 machine. HRUS parameters studied included cross-sectional area (CSA) of the nerve, fascicular architecture and abnormal blood flow (by colour Doppler). CSA was measured at the wrist (S1), 5 cm above the wrist (S2), 10 cm above the wrist (S3), mid-forearm (S4) and at the elbow (S5). Results 30 median nerves from 22 cases of leprosy and 30 nerves from 15 healthy subjects were compared. Among cases, 8 were borderline tuberculoid, 9 borderline lepromatous, 3 lepromatous leprosy, and 2 indeterminate leprosy. Abnormal motor (76.7%) and sensory conduction (96.7%) was noted in the patient group. The mean CSA was 18.5 mm2 at S1, 20.3 mm2 at S2, 14.1 mm2 at S3, 9.1 mm2 at S4, and 8.1 mm2 at S5. The CSA at S1 and S2 were significantly higher compared to other sites. CSA values were significantly higher in patients compared to controls. The fascicular architecture was distorted in patients - grade II (33.3%), III (40.0%) and IV (20%), and hypervascularity was noted in 26.6%. Conclusion HRUS depicted characteristic features of the median nerve in leprosy - maximum enlargement in the distal forearm with distorted fascicular architecture.

Highlights

Hansen’s disease, commonly known as leprosy, is a chronic debilitating disease of the skin and peripheral nerves caused by infection with Mycobacterium leprae.[1]
Written informed consent was obtained from all the healthy participants; a consent waiver for the retrospective cases was approved by IEC
High-resolution ultrasonography (HRUS) is of immense value in detecting median nerve enlargement and in evaluating the echo texture and blood flow as highlighted in our study

Summary

Introduction

Hansen’s disease, commonly known as leprosy, is a chronic debilitating disease of the skin and peripheral nerves caused by infection with Mycobacterium leprae.[1]. According to the recent WHO report, India reported 120,334 newly diagnosed patients with leprosy in 2018 and is the country with the highest incidence rate of leprosy in the South East Asia region.[2]. During the clinical course of the disease, M. leprae infects Schwann cells located in the peripheral nerves, leading to damage to these nerves, manifesting irreversible deformities and functional disabilities of limbs.[3] The peripheral nerve enlargement occurs early in the disease course, even before the initial clinical symptoms, and if left undiagnosed and untreated, may result in irreversible nerve damage. Early detection of nerve damage is the most crucial aspect in the management of patients with leprosy.[4]

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