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Tropical Neurology - part 3

Bệnh phong đường biên giới nằm giữa hai loại cực, tuberculoid và lepromatous bệnh phong. Một số bệnh nhân có thể được gần với tuberculoid (đường biên giới tuberculoid hoặc loại BT), một số gần với cuối lepromatous (lepromatous đường biên giới hoặc loại BL) và một số có thể nằm trong nhóm | Leprosy 99 Fig. 6.1. Indeterminate type of leprosy. The patch is hypopigmented flat and not well defined courtesy of Dr. B. K. Girdhar . 6 Borderline Leprosy Borderline leprosy lies between the two polar types tuberculoid and leproma-tous leprosy. Some of the patients may be nearer to tuberculoid borderline tuberculoid or BT type some closer to the lepromatous end borderline lepromatous or BL type and some may lie in middle group BB type Fig. 6.3 6.4 . The clinical features in these patients are a combination of the two polar types and are summarized in Tables 6.1 and 6.2. 100 Tropical Neurology 6 Fig. 6.2. Tuberculoid leprosy. The patch is well defined with raised edges and commencing healing in the middle courtesy of Dr. B. K. Girdhar . Pure Neuritic Type This is a clinical type of leprosy found more commonly in India. The lesions are exclusively in the nerves the skin being totally unaffected. Peripheral anesthesia corresponds to the damaged nerves. When there are no skin lesions and a patient presents with glove and stocking anesthesia leprosy should always be excluded especially in an endemic area. Peripheral anesthesia and thickening of the corresponding nerves clinches the diagnosis. When nerve thickening is doubtful biopsy of a cutaneous nerve should be performed. Fortunately nerve involvement in tuberculoid and borderline leprosy is often restricted to only one nerve or a few funicles of a nerve. These thickened funicles can readily be identified by a 2x magnification corneal loupe and can be taken out using fine iris forceps and scissors. The risk of causing a significant sensory loss can be greatly minimized if biopsy is performed on the index branch of the radial cutaneous nerve. The sensory loss thus produced is minimal and recovers within three months. Reactions One of the major complications of leprosy is the reaction . A reaction may be defined as an acute exacerbation of the disease. The reactions in the borderline and tuberculoid types are called