Frequency of neurological deficits in Sudanese lepromatic patients

Abstract

Leprosy has been a major burden on humanity over thousands of years. Perhaps no other disease in the history of mankind has been associated with such a strong social stigma as leprosy. Failure in early detection often leads to severe disability in spite of eradication of mycobacteria at a later date. Untreated the disease is progressive and results in permanent damage to the skin, nerves, limbs and eyes.
Objectives: To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology Hospital in the period from March 2006 to August 2006.
Methodology: This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple, direct, standardized questionnaire including history and neurological examination, during the period from March to August 2006.
Results: The most common age group affected was 18- 27 years. Male to female ratio was 3:1. Numbness was the most common neurological symptom seen in 77.14%. Each of visual disturbance, headache and bilateral ulnar sensory impairment was detected in 7.14%. Half of the
patients had upper limbs sensory nerve dysfunction while 42.86% exhibited sensory nerve dysfunction in the lower limbs. "Gloves and stoking" sensory impairment was the most common finding (30%) while bilateral lateral popliteal sensory impairment was seen with the same
percentage. Bilateral median and unilateral posterior tibial sensory impairment were found in 1.43% each. Unilateral radial cutaneous sensory impairment was seen in 2.86%. Approximately half (48.57%) of the patients had upper limbs motor dysfunction. Bilateral ulnar distribution motor affection was seen in 40%. A significant number (41.43%) had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86%. Leprosy reactions were detected in 21.43%; type 2 reaction in 14.29% while type 1 reaction in 7.14%. Conclusion: Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. Peripheral nerve sensory impairment was found in half of the patients with "Gloves and stokes" peripheral sensory neuropathy being the most common sensory disturbance. Motor dysfunction was found in 48.57%. Ulnar and median nerves motor affection was the most common motor dysfunctions. Signs related to cranial nerves involvement were less common. Leprosy reactions were present in one-fifth of the patients.

Keywords: Mycobacterium leprae, granulomatous, numbness, popliteal