Agrawal Abhishek, Garg Ravindra K, Malhotra Kiranpreet, Malhotra Hardeep S, Rizvi Imran, Kumar Neeraj, Suvirya Swastika, Sharma Praveen K, Verma Rajesh, Uniyal Ravi, Pandey Shweta
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Family Med Prim Care. 2022 Aug;11(8):4496-4499. doi: 10.4103/jfmpc.jfmpc_2480_21. Epub 2022 Aug 30.
In approximately 25% of peripheral neuropathy cases, diagnosis remains obscure. In India, leprosy continues to remain one of the most frequent causes of peripheral neuropathy. We, in this prospective evaluation, performed nerve biopsies in patients with peripheral neuropathy for early confirmation of the diagnosis.
A total of 55 consecutive cases of peripheral neuropathy were included in this study. All patients were subjected to clinical and electrophysiological evaluation. Sural nerve biopsies were performed in all the patients.
After a nerve biopsy in 29 cases, we were able to identify the underlying cause of peripheral neuropathy. In 26 cases, the diagnosis remained obscure. The most frequent histopathological diagnosis was leprosy, which was seen in 20 cases. Other diagnoses were chronic demyelinating neuropathy (four cases), vasculitis (two cases), and amyloidosis in one case. In two biopsies, the findings were consistent with hereditary neuropathies. The demonstration of lepra bacilli was the most distinctive feature. In addition, foamy macrophages (100%) and granuloma (100%) formation, epineurial (83.3%) and endoneurial infiltration (69%) along with epineurial (87.5%) and perineurial thickening (77.3%) were also noted more frequently in leprosy-associated neuropathy.
The nerve biopsies revealed that leprosy was the most common etiology in patients with peripheral neuropathy. In approximately 47% of the cases, even nerve biopsies failed to establish a confirmed diagnosis.
在大约25%的周围神经病变病例中，诊断仍不明确。在印度，麻风病仍然是周围神经病变最常见的病因之一。在这项前瞻性评估中，我们对周围神经病变患者进行了神经活检，以尽早确诊。
本研究共纳入55例连续的周围神经病变患者。所有患者均接受了临床和电生理评估。所有患者均进行了腓肠神经活检。
对29例患者进行神经活检后，我们能够确定周围神经病变的潜在病因。26例患者的诊断仍不明确。最常见的组织病理学诊断是麻风病，有20例。其他诊断包括慢性脱髓鞘性神经病变（4例）、血管炎（2例）和淀粉样变性1例。在2例活检中，结果与遗传性神经病变一致。麻风杆菌的显示是最显著的特征。此外，在麻风相关神经病变中，还更频繁地观察到泡沫状巨噬细胞（100%）和肉芽肿（100%）形成、神经外膜（83.3%）和神经内膜浸润（69%）以及神经外膜（87.5%）和神经束膜增厚（77.3%）。
神经活检显示，麻风病是周围神经病变患者最常见的病因。在大约47%的病例中，即使进行神经活检也未能确诊。
