Iwata Makoto
Tokyo Women's Medical University, Tokyo, Japan.
Brain Nerve. 2011 Feb;63(2):157-64.
For the last 5 years, not a single new case of leprosy has been reported among native Japanese people, but several new cases of leprosy have been reported every year among foreigners in Japan. Because most leprosy patients consult doctors not for skin rashes but for the neurological symptoms of leprous neuropathy, every neurologist should be well aware of the clinical features of leprous neuropathy. The finding that the clinical pictures of leprous neuropathy differ greatly between patients from the main Japanese islands and those from Okinawa is of clinical importance the former comprise the lepromatous type while the latter are of the borderline group. The clinical features of leprous neuropathy among people from leprosy-prone areas in the world wide are usually of the tuberculoid type or of the borderline group. Further, the clinical pictures of each type of leprous neuropathy are so distinct that these conditions can be diagnosed with the simple classical neurological examination. One of the most important issues in managing leprosy patients with neurological deficits is protection of the areas of analgesia caused by leprous neuropathy from injuries or burns. Protection against entrapment neuropathies of thickened peripheral nerve trunks, which are quite likely to be compressed during various activities of daily living, is also important.
在过去5年里,日本本土居民中未报告过一例新的麻风病例,但在日本的外国人中每年都有几例新的麻风病例报告。由于大多数麻风患者就医并非因为皮疹,而是麻风性神经病的神经症状,每位神经科医生都应充分了解麻风性神经病的临床特征。来自日本主要岛屿的患者与来自冲绳的患者相比,麻风性神经病的临床表现差异很大,这一发现具有临床重要性,前者为瘤型,而后者属于界线类。世界各地麻风流行地区人群中麻风性神经病的临床特征通常为结核样型或界线类。此外,每种类型的麻风性神经病的临床表现都非常独特,通过简单的经典神经检查即可诊断这些疾病。管理有神经功能缺损的麻风患者最重要的问题之一是保护因麻风性神经病导致的感觉缺失区域免受损伤或烧伤。防止增厚的周围神经干发生卡压性神经病也很重要,在日常生活的各种活动中,这些神经干很可能会受到压迫。