Dastur D K
Neurosurg Rev. 1983;6(3):139-52. doi: 10.1007/BF01742765.
A very brief review of the literature on the clinicopathological aspects of leprosy is given; mainly through references. The salient features of the two main types of leprosy--tuberculoid and lepromatous--are presented in a Table. The surgical and pathological findings are briefly described and the pathogenesis of involvement of the facial nerve (a motor nerve) is discussed. On the basis of (i) the severe histopathologic changes (degeneration) of the most distal part of the zygomatic branch of the facial nerve (innervating the orbicularis oculi), with sparing of the roots of all branches and the trunk of the nerve; (ii) the concurrent loss of cutaneous sensations in the territory of the maxillary division of the trigeminal nerve (the region of the zygoma and the lower eyelid); and (iii) the close approximation or even anastomoses occurring between the ultimate branches of these two nerves, it is postulated that paralysis of orbicularis oculi occurs secondarily to the sensory nerve damage, i.e. due to spread of infection from the sensory branches of the trigeminal to the motor branches of the facial nerve. The surgical and pathological findings of the nerves in the arm, especially the ulnar and the median and their branches are described, in tuberculoid and lepromatous leprosy. The forms of nerve degeneration, the occasional axon regeneration, and the role of the Schwann cell in harbouring the bacilli, are illustrated. The lysosomal enzyme activity in the Schwann cells of nerve fibres, particularly of unmyelinated fibres which preferentially phagocytose the M. leprae, and their role, albeit not very successful, in degrading the bacilli and controlling the infection, are also stressed, through light and electronmicrographs. The constellation of secondary factors of the terrain operating to produce further damage to primarily diseased nerves, is discussed. These factors include indirect compression from unyielding fibroosseous tissues, minor traumata, stretching of the nerves, and their exposure to lower temperatures in subcutaneous tissues.
本文主要通过参考文献对麻风病临床病理学方面的文献进行了简要综述。以表格形式呈现了两种主要麻风类型——结核样型和瘤型的显著特征。简要描述了手术和病理结果，并讨论了面神经（运动神经）受累的发病机制。基于以下几点：（i）面神经颧支最远端部分（支配眼轮匝肌）出现严重的组织病理学变化（变性），而所有分支的根部和神经干未受累；（ii）三叉神经上颌支区域（颧骨和下眼睑区域）同时出现皮肤感觉丧失；（iii）这两条神经的终末分支紧密相邻甚至吻合，推测眼轮匝肌麻痹继发于感觉神经损伤，即由于感染从三叉神经的感觉支扩散至面神经的运动支。描述了结核样型和瘤型麻风病患者手臂神经，尤其是尺神经、正中神经及其分支的手术和病理结果。阐述了神经变性的形式、偶尔的轴突再生以及施万细胞在容纳杆菌中的作用。通过光学显微镜和电子显微镜照片强调了神经纤维，特别是优先吞噬麻风杆菌的无髓纤维的施万细胞中的溶酶体酶活性，以及它们在降解杆菌和控制感染方面虽不太成功但仍发挥的作用。讨论了导致对原发性患病神经产生进一步损害的一系列次要因素。这些因素包括坚硬的纤维骨性组织的间接压迫、轻微创伤、神经拉伸以及它们在皮下组织中暴露于较低温度。
