High resolution sonography to detect nerve damage in leprosy - A case control study

Background and objectives: Leprosy is an infectious chronic granulomatous disease which primarily affects the skin and nerves. It can lead to severe nerve damage and furthermore deformities if not detected in time. In this study we have used high resolution USG and Colour Doppler to diagnose nerve damage and nerve changes in leprosy and lepra reactions .
AIMS AND OBJECTIVES: To evaluate the role of high resolution ultrasonography to assess peripheral nerve damage in leprosy and to compare the nerve involvement in leprosy patients with healthy controls.
METHODOLOGY: Twenty cases of leprosy were taken and bilateral USG and CD of ulnar, median, lateral popliteal, posterior tibial nerves was performed. Twenty age and sex matched controls were taken and USG findings of both cases and controls were compared.
RESULTS: Mean CSA of ulnar nerve was 19.66mm2, median nerve 15.15mm2 , lateral popliteal 15.84mm2 and of posterior tibial 15.35mm2 respectively in cases and 7.94mm2,5.4mm2,7.8mm2 ,8.6mm2 respectively in controls.Out of 20 cases, increased vascularity on CD was seen in 9(45%) patients . Moderate echoreflectivity was seen in six(30%) cases.
CONCLUSION: USG is a cost effective, rapid, imaging technique as to detect early damage and extent of nerve damage in the leprosy. Clinical examination of the nerves is a very subjective method where as USG provides us an objective measure. Hence it should be included as a routine procedure to supplement clinical diagnosis of leprosy. Early diagnosis of nerve damage will help in prevention of disability and its complications.