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ULTRASONOGRAPHY AS A DIAGNOSTIC TOOL FOR NEURAL PAIN IN LEPROSY
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Universidade Federal do Estado do Rio de Janeiro. Programa de Pós-Graduação em Neurologia. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Estado do Rio de Janeiro. Programa de Pós-Graduação em Neurologia. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Estado do Rio de Janeiro. Programa de Pós-Graduação em Neurologia. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Estado do Rio de Janeiro. Programa de Pós-Graduação em Neurologia. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Estado do Rio de Janeiro. Programa de Pós-Graduação em Neurologia. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil.
Abstract
Leprosy is still a prevalent disease in Brazil, representing 93% of all occurrences in the
Americas. Leprosy neuropathy is one of the most worrying manifestations of the disease.
Acute neuropathy usually occurs during reaction episodes and is called neuritis. Twenty-two
leprosy patients were included in this study. These patients had neural pain associated with
ulnar sensory neuropathy, with or without adjunct motor involvement. The neurological picture
began within thirty days of the clinical evaluation. The patients underwent a nerve conduction
study and the demyelinating findings confirmed the diagnosis of neuritis.
Ultrasonographic study (US) of the ulnar nerve was performed in all patients by a radiologist
who was blinded to the clinical or neurophysiological results. Morphological characteristics
of the ulnar nerve were analyzed, such as echogenicity, fascicular pattern, transverse
cross-sectional area (CSA), aspect of the epineurium, as well as their anatomical relationships.
The volume of selected muscles referring to the ulnar nerve, as well as their echogenicity,
was also examined. Based on this analysis, patients with increased ulnar nerve
CSA associated with loss of fascicular pattern, epineurium hyperechogenicity and presence
of power Doppler flow were classified as neuritis. Therefore, patients initially classified by
the clinical-electrophysiological criteria were reclassified by the imaging criteria pre-established
in this study as with and without neuritis. Loss of fascicular pattern and flow detection
on power Doppler showed to be significant morphological features in the detection of neuritis.
In 38.5% of patients without clinical or neurophysiological findings of neuritis, US identified
power Doppler flow and loss of fascicular pattern. The US is a method of high resolution
and portability, and its low cost means that it could be used as an auxiliary tool in the diagnosis
of neuritis and its treatment, especially in basic health units.
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