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CASE REPORT
Year : 1997  |  Volume : 63  |  Issue : 5  |  Page : 317-319

Cervical canal stenosis masquerading as neuritis in a case of borderline tuberculoid leprosy




Correspondence Address:
S K Sayal


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Source of Support: None, Conflict of Interest: None


PMID: 20944366

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  Abstract 

A 40-year old male presented with typical features of leprosy borderline tuberculoid (BT) type. During the course of treatment, he developed neurological features which were initially attributed to neuritis. However, these features progressed despite antileprosy treatment. Detailed investigations revealed compressive myelopathy due to cervical canal stenosis. He was managed successfully with appropriate surgical treatment.


Keywords: Cervical canal stenosis, Neuritis, Leprosy


How to cite this article:
Sayal S K, Das A L, Mahapatra A K, Singh P. Cervical canal stenosis masquerading as neuritis in a case of borderline tuberculoid leprosy. Indian J Dermatol Venereol Leprol 1997;63:317-9

How to cite this URL:
Sayal S K, Das A L, Mahapatra A K, Singh P. Cervical canal stenosis masquerading as neuritis in a case of borderline tuberculoid leprosy. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Jun 17];63:317-9. Available from: http://www.ijdvl.com/text.asp?1997/63/5/317/4605


Leprosy is a chronic mycobacterial disease affecting the peripheral nervous system and secondarily involving skin and other tissues.[1] Hence neurological dysfunctions are common in leprosy. However, leprosy should not be overstressed as other neurological conditions, at times, may be responsible for the neurological manifestations in a case of leproy.[2] Recently we came across a case of leprosy (BT) having concomitant cervical canal stenosis with associated complications, which is being reported.


  Case Report Top


A 40-year-old male presented with, slowly progressive reddish skin lesions on face and right forearm of 4 months duration. General physical and systemic examinations did not reveal any abnormality. Dermatological examination revealed two partially well-defined erythematous hypoesthetic plaques of sizes 12cm x 10cm and 10cm x 8cm on right elbow and left side of forehead respectively. Both ulnar and left posterior tibial nerves were thickened and nontender. Slit-skin smear for AFB was negative. Skin biopsy was consistent with leprosy (BT). He was managed with multidrug therapy (WHO, paucibacillary leprosy) consisting of DDS and rifampicin. One month after starting treatment he complained of tingling sensation in both hands. Neurological examination did not reveal any sensory or motor deficit. His symptomatology was attributed to neuritis and managed with nonsteroidal antiinflammatory drugs, systemic steroids and clofazimine. Despite all measures, his symptomatology persisted and progressed to appear in lower limbs. Reassessment at this stage revealed hyperreflexia of tendon jerks. Radiological examination of cervical spine revealed congenital fusion of cervical vertebrae (C2 and C3) and cervical spondylosis. Neurological consultation was sought. A compressive myelopathy was considered. CT scan revealed congenital fusion of C2 and C3 vertebrae with cervical canal stenosis at C4 and C5 level. MRI confirmed above findings and also showed oedema at C3 and C4 levels [Figure - 1].

Neurosurgical intervention was undertaken with C2 to C5 laminectomy and anterior decompression. There has been dramatic subjective improvement, though hyperreflexia is persisting. He is now under regular follow up and is progressing satisfactorily.


  Discussion Top


Leprosy manifests with characteristic skin lesions and / or nerve enlargement with neurological signs and symptoms. However, many other conditions causing peripheral neuropathy, as also diseases of spine and spinal cord can give rise to neurological features simulating neuritis.[2] The situation becomes more confusing when any of these condition is present concomitantly in a case of leprosy. Congenital stenosis or narrowing of cervical spinal canal is an uncommon condition. However it is extremely important to recognise it, as it predisposes patients to spinal cord injury during sporting activities and other trauma. The cervical spinal cord can be endangered in adult life due to progressive spondylosis and also protrusion, which further compromises the spinal canal and leads to compressive myelopathy. This may manifest as neck pain, paresthesia, weakness of extremities, ataxia or spasticity.[3] Diagnosis can be confirmed by skiagram, CT scan and MRI.

Our patient presented with typical features of leprosy (BT) clinically, and histologically. Later he developed paresthesia on ulnar side of both hands and forearms which was initially considered to be due to neuritis in leprosy in view of involvement of both ulnar nerves. However, after sometime, when patient developed paresthesia in lower limbs and hyperreflexia, cervical spinal cord pathology was cosidered. X-ray of cervical spine, CT scan and MRI revealed cervical canal stenosis, cervical spondylosis and oedema of cervical spinal cord. A timely neurosurgical intervention prevented possible neurological complications and catastrophy. This case emphasizes the significance of an accurate neurological assessment in a case of leprosy, wherein the pre-existing peripheral nerve trunk involvement may tend to obscure the features of other concomitant disease involving central nervous system or spinal cord.



 
  References Top

1.Jopling WH. Definition, epidemiology and world distribution, In : Handbook of Leprosy, 3rd ed, William Heinemam Medical Book Ltd, London 1984;1-7.  Back to cited text no. 1    
2.Nunzi E, Fiallo P. Differential diagnosis, in: Leprosy, Edited by Hastings RC, Opromolla DVA, 2nd ed, Churchill Livingston, Edinburg 1994;291-313.  Back to cited text no. 2    
3.Bohlman HH. Neck, In : Minute Sekeletal Disorders, Edited by D'Ambrosis R D, 2nd ed, JB Lippincot company, Philadelphia 1986;219-286.  Back to cited text no. 3    


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