麻风病中的正中神经损伤：它与经典的腕管综合征有何不同？
Median nerve impairment in leprosy: how does it differ from the classic carpal tunnel syndrome?
作者信息
Alves Pedro Henrique Sirotheau Corrêa, Cirino Fernanda de Oliveira, Garcia Leonardo Peixoto, Fernandes João Paulo Moreira, Luppi Andrea De Martino, Antunes Douglas Eulálio, Pereira Raquel Campos, Junior Wilson Marques, Goulart Isabela Maria Bernardes, Santos Diogo Fernandes Dos
机构信息
Universidade Federal de Uberlândia, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência Nacional em Hanseníase e Dermatologia Sanitária, Uberlândia MG, Brazil.
Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Uberlândia MG, Brazil.
出版信息
Arq Neuropsiquiatr. 2024 Dec;82(12):1-6. doi: 10.1055/s-0044-1792092. Epub 2024 Dec 10.
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 ( = 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 ( < 0.0001), with an average of 6.6 ± 1.3 and 17.0 ± 6.7, respectively ( < 0.001). Finally, 88.9% of the nerves in the PNL group and only 7.4% in the CSA ( < 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 ( < 0.0001).
CONCLUSION
The presence of neural thickening and demyelinating impairment in the segments proximal to the carpal tunnel favors the diagnosis of leprosy.
背景
腕管综合征（CTS）已被描述为神经麻风表现的一种可能形式。然而，正中神经在近端节段可能会累及这种神经病变，并且有时指支会出现不对称性损害。
目的
通过神经传导研究（NCS）和超声评估详细描述正中神经损害模式。
方法
这项横断面研究包括15例原发性神经麻风（PNL）患者和14例腕管综合征患者，他们接受了周围神经超声检查和NCS评估。
结果
总体而言，92.8%的腕管综合征患者和80%的原发性神经麻风患者正中神经双侧受损，每组各有27条神经。考虑到腕管（Mt）段的横截面积（CSA），腕管综合征组63%的神经和原发性神经麻风组74.1%的神经增粗，平均CSA分别为13.4±4.4和12.4±4.6（P=0.18）。近端腕管（Mpt）段的CSA仅在腕管综合征组3.7%的神经中增粗，而在原发性神经麻风组为96.3%（P<0.0001），平均分别为6.6±1.3和17.0±6.7（P<0.001）。最后，原发性神经麻风组88.9%的神经和CSA组仅7.4%的神经在前臂远端传导速度降低，平均分别为41.0±6.3和53.2±5.2（P<0.0001）。
结论
腕管近端节段存在神经增粗和脱髓鞘损害有利于麻风的诊断。
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