The Diagnosis of Leprosy - Part II. The 2 nd cardinal signs of - - PowerPoint PPT Presentation

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The Diagnosis of Leprosy - Part II. The 2 nd cardinal signs of - - PowerPoint PPT Presentation

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The Diagnosis of Leprosy - Part II. The 2 nd cardinal signs of leprosy Salvatore Noto, Pieter A M Schreuder and Bernard Naafs Leprosy mailing list, October 2011

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  • The Diagnosis of Leprosy - Part II.

The 2nd cardinal signs of leprosy

  • Salvatore Noto, Pieter A M Schreuder and Bernard Naafs

Leprosy mailing list, October 2011

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  • Peripheral nerve involvement in leprosy
  • thickened;
  • small and hard;
  • irregular in consistency;
  • tender;
  • spontaneous pain;
  • nerve function deficit (sensory, motor,

autonomic).

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  • ! "#

$ % & ' ( ) ( "! # "((#

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$

Routinely palpated nerves “of predilection” in leprosy

  • !

"# $ %

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%

Examination of nerves

  • &%''

'(

  • )*+++,(
  • -&''

&

.'/0(11 23'45"6

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&

Supra orbital nerve

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'

%

Courtesy of S. Noto

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)

7-' %8 %

Large cervical plexus and branch of the supra-orbital nerve associated with small lesions beside the eye. Leprosy patient in Hong Kong.

Courtesy of Grace Warren

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  • Leprosy,

enlarged great auricular nerve.

Courtesy of S. Noto

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  • Leprosy, enlarged great auricular nerve

Courtesy of B. Naafs

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  • BL leprosy

Enlarged great auricular nerve

Courtesy of B. Naafs

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$

  • Courtesy of S. Noto
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%

#'

Have you ever seen large ulnar nerves at the elbow? Well here they are. Her right more than the left. But as yet she has no

  • bvious neural deficit in the hands (G. Warren).

Courtesy of Grace Warren

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&

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'

  • 2-6
  • -&

1& %& 90&'1

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)

Palpation of the radial cutaneous nerve

Courtesy of B. Naafs

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  • Enlarged radial cutaneous nerve

Leprosy, patient from Brazil

Courtesy of S. Noto

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  • Enlarged radial cutaneous nerve

Leprosy, patient from Brazil

Courtesy of S. Noto

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  • !
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  • Leprosy

The drawings show the position of the enlarged median and radial cutaneous nerves

Courtesy of A. Salafia, India

Median nerve

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  • Leprosy,

enlarged left median nerve

Courtesy of B. Naafs

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$

#

"((#

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%

Palpation of enlarged lateral popliteal nerves

Courtesy of B. Naafs

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&

Palpation of the lateral popliteal nerves *+

Courtesy of S. Noto

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'

:

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)

:

Large superficial peroneal nerve, often easily

  • palpable. This one also nodulated. This would

imply small abscesses in the nerve. Patient does not complain of pain or discomfort.

Courtesy of Grace Warren

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  • Enlarged superficial peroneal and sural nerves (and loss of sensation)

Courtesy of B. Naafs

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  • %
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  • Palpation of the

posterior tibial nerve

Courtesy of B. Naafs

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  • ;
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  • Courtesy of Grace Warren

Large superficial nerve on a thigh with a hypopigmented lesion in association

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$

Any nerve!

Courtesy of B. Naafs

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%

Check all nerves!

Courtesy of B. Naafs