User talk:LEITHEAD

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Nerve damage in leprosy Colin L. Crawford; MRCP Leprosy is considered to be a disease in which nerve damage is caused by bacterial invasion of the peripheral nerves. There is involvement of  nerves such as the  ulnar, median, and common peroneal. If an individual nerve is involved it is called a mononeuritis, if several a mononeuritis multiplex. Leprosy was a common infection in Norway in the 19th century, with as many as 200 new cases annually New cases also occurred  in the 20th century and 63 of them were clinically examined by Monrad –Krohn, a prominent neurologist.1 He concluded that there was a sensory polyneuritis involving superficial sensory modalities. There were many illustrations, one of which is shown in the Figure, demonstrating the glove and stocking distribution. This distribution is not unique to leprosy, occurring in other disorders such as diabetic neuropathy. If the sensory loss was caused by invasion of the nerves by Mycobacterium leprae, the bacteria would have to enter the limbs on each side at the same time and in the same concentration as the distribution is symmetrical. The sensory loss in leprosy is therefore not caused by invasion of the peripheral nerves by M.leprae. The bacteria do invade the nerves, but are also present in other tissues such as smooth and striated muscles, without causing any tissue damage. They can also invade the white blood cells in the multi-bacillary patient without causing a rise in temperature. It is probable that the sensory loss is due to an autoimmune response to an antigen in sensory nerves and there is clinical and experimental evidence for this hypothesis. Despite these comprehensive findings by a noted neurologist, sensory polyneuritis is not mentioned as cause of nerve damage by leprologists or neurologists, although Monrad-Krohn’s findings were confirmed in a group of northern Nigerian patients..2 Patients with a mononeuritis or multiple moneuropathy do  not develop  mutilated extremities, foot ulcers or disintegration of  the tarsal bones (Charcot joints), which are due to the polyneuritis. Manuscripts including this diagram have been sent to the Lancet, BMJ, JAMA and several other journals but have been rejected without peer review. In 2004, it was sent as an image to the New England Journal of Medicine. It was rejected without peer review by Baden4 whose comments are enclosed. Although ‘interesting’, it was apparently of little significance. 1. Monrad-Krohn GH. The neurological aspect of leprosy. Christina: Jacob Dybwad,. 1923: p 56. 2. Crawford CL. Neurological lesions in leprosy. Lepr. Rev. 1968; 39, 9-13. ….. Enclosure.

Legend to the Figure

Doc James (talk · contribs · email) 15:48, 4 October 2018 (UTC)

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