Leprosy: report of a case with severe peripheral neuropathy

Leprosy (Hansen’s disease) is a chronic granulomatous infectious disease, caused by Mycobacterium leprae, with cutaneous and neurological manifestations. Leprosy is very rare in Europe but some cases are reported, especially among people coming from endemic areas. Here, we report a case of Hansen’s disease and emphasize the importance of a prompt diagnosis and treatment also in non-endemic areas.     

Solitary plasmacytoma presenting as peripheral neuropathy: a case report.

We report a 26 year old woman presenting with a chronic predominantly motor radiculoneuropathy. A biopsy proven solitary lytic plasmacytoma was detected in the left sixth rib. Serum immunoelectrophoresis revealed 'M' band (IgG, l light chain). Excision of the plasmacytoma resulted in gradual but steady recovery. We suggest that all patients with 'cryptogenic' polyneuropathy be investigated for this potentially treatable condition. A high index of suspicion assists the organization of appropriate diagnostic investigations.     

Styrene-induced peripheral neuropathy. A case report

A case of peripheral neuropathy due to styrene is described. The diagnosis of peripheral neuropathy was confirmed by a motor-nerve conduction study and sural nerve biopsy.     

Hypoglycaemic neuropathy: a case report

A 53 years old male, a known case of ankylosing spondylitis having recurrent attacks of hypoglycaemia, developed symmetrical distal sensorimotor neuropathy. The neuropathy was axonal with secondary demyelination. Evidence of vasculopathy was also noted on histopathology of the nerve. Serum C-peptide level was low, a feature reported with autoimmune hypoglycaemia with antireceptor antibodies. The patient showed spontaneous recovery.     

Metronidazole neuropathy: a case report

A 67-year-old man developed peripheral neuropathy characterized by glove and stocking type sensory disturbances after the ingestion of 101.25 g of metronidazole for hepatic amebiasis. The clinical pictures of metronidazole-induced neuropathy appears to be the same as that of myeloneuropathy. The morphological study of a sural nerve biopsy showed a severe loss of myelinated fibers (2,400 per mm2). The density of unmyelinated fibers was at a lower limit of the normal range (23,530 per mm2). Electronmicroscopy confirmed the axonal degeneration of both the myelinated fibers and unmyelinated fibers.     

A somatic type delusional disorder secondary to peripheral neuropathy: a case report

Delusional disorders are one of the psychiatric disorders with unknown etiology. Various factors have been considered as risk factors (predisposing factors) for delusional disorders. Positive family history of psychiatric disorders particularly delusional disorders, is the most important risk factor. In this report, we present a 40-year old man with somatic delusions following intoxication with Phenobarbital and left brachial plexus injury (C6, C7, C8) in stupor state. Two weeks after discharge from the hospital, he developed a significant somatic delusion about his left upper extremity. To our knowledge, somatic delusions secondary to peripheral neuropathy has not been reported up to now therefore this case illustrates a very rare organic delusional disorder.     

Neurophysiological evaluation of associated demyelinating peripheral neuropathy and multiple sclerosis: a case report.

A case of combined multiple sclerosis and demyelinating neuropathy is presented. Percutaneous electrical stimulation of the cortex and spinal cord has shown that pyramidal tract conduction time was prolonged and conduction velocity in the cord was 4 m/s. Motor conduction velocity in proximal segments of peripheral nerves was slowed to the same extent as in distal segments.     

Acute autonomic and sensory neuropathy: a case report

Summary A female patient with acute autonomic and sensory neuropathy is described. Urinary disturbance developed rapidly and was followed by orthostatic syncope, absence of lacrimation, salivation and sweating, and sensory impairment. Muscle strength had been consistently normal despite diffuse muscular atrophy. Marked decrease in the number of small myelinated and unmyelinated fibres was revealed in biopsied sural nerve. Eighteen months after the onset, her autonomic symptoms have partially improved.     

Cryoglobulinemic neuropathy: case report

We report the case of a 51-year-old man affected by mainly motor polyneuropathy with subacute onset and tendency to chronicization. Several possible etiological factors were present, but nerve biopsy, showing ischemic and inflammatory neuropathy, led us to consider cryoglobulinemia as the most important.

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Sommario Viene descritto il caso clinico di un uomo di 51 anni con polineuropatia principalmente motoria ad esordio subacuto e con tendenza alla cronicizzazione. La biopsia del nervo surale permette, evidenziando una neuropatia ischemica infiammatoria, di escludere il ruolo eziologico di altri concomitanti fattori di rischio, concludendo per una polineuropatia crioglobulinemica.

     

Organophosphate-induced delayed neuropathy: case report

Organophosphate induced delayed neuropathy (OPIDN) is an uncommon clinical condition. It occurs in association with the ingestion of great amounts of organophosphate after the stimulation of cholinergic receptor. The clinical picture is characterized by a distal paresis in lower limbs associated with sensitive symptoms. Electrodiagnostic studies show a motor axonal neuropathy. Involvement of the central nervous system may occur. We describe a 39 years-old female patient who developed hyperesthesia associated with lower limbs paresis, fourteen days after she had ingested a Dichlorvos-based insecticide. Electrophysiological study was characterized by an axonal polyneuropathy pattern. Pyramidal tract dysfunction was observed later in upper limbs. Considering that both peripheral and central nervous systems are involved we believe that the more appropriated term would be organophosphate induced delayed neuropathy (OPIDN) instead of organophosphate induced delayed polyneuropathy (OPIDP).     

Association of neuromyotonia with peripheral neuropathy, myasthenia gravis and thymoma: A case report

A case of neuromuscular hyperactivity syndrome associated with a thymoma, high serum titres of anti-acetylcholine receptor and anti-DNA antibodies is reported. The study of peripheral nerve conduction revealed a peripheral neuropathy. Repetitive stimulation showed a decrease in the fifth M response. Myasthenic symptoms were anamnestically reported but were absent at clinical observation. The clinical picture and EMG examination improved after phenytoin administration.

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Sommario è riportato un caso caratterizzato da sindrome da iperattività neuromuscolare associata a timoma, alti titoli di anticorpi anti-recettore dell'acetilcolina e anti-DNA. Lo studio della conduzione del nervo periferico ha evidenziato una neuropatia periferica. La stimolazione ripetitiva ha evidenziato un incremento della V risposta M. Al momento dell'osservazione clinica non erano presenti sintomi miastenici, riferiti invece anamnesticamente. Sia il quadro clinico che quello elettromiografico sono migliorati dopo somministrazione di fenitoina.

     

Amitriptyline-related peripheral neuropathy. Case report

Although amitriptyline is not usually regarded as toxic to the peripheral nervous system (PNS) and is even prescribed by some for neuropathic pain, there are sporadic reports of peripheral neuropathy following overdose or prolonged use of the drug. The scarcity of data leads us to report a case we have followed for 3 years clinically and electromyographically. A 54 year old man on oral amitriptyline 150 mg uninterruptedly for 2 years consulted us for lower limb paresthesias and was found on clinical examination to have reduced ankle jerks and mild distal global hypoesthesia. EMG yielded a pattern of sensorimotor neuropathy compatible with axonal disease in all four limbs. The history was unremarkable and the laboratory data were within normal limits. After discontinuation of amitriptyline therapy both the clinical and EMG pattern gradually normalized. We draw attention to the possible risk, infrequent though it is, of PNS neurotoxicity of a widely used drug reputedly harmless from this point of view.

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Sommario Anche se l’Amitriptilina non è considerata di solito come agente neurotossico sul Sistema Nervoso Periferico (ed anzi viene prescritta da taluni in caso di dolori da neuropatia), tuttavia esistono in letteratura sporadiche segnalazioni che evidenziano come, in certi pazienti, possa svilupparsi un quadro di neuropatia periferica, sia da ingestione massiccia del farmaco, che dopo un suo uso prolungato. Proprio la scarsità dei dati della letteratura al proposito ci ha indotto a segnalare un caso da noi osservato, e seguito per tre anni sia dal punto di vista clinico che elettrografico. Trattasi di un uomo di a.54, a cui era stata prescritta Amitriptilina per os al dosaggio di 150 mgr/pro die: tale terapia era stata seguita senza interruzioni per più di due anni. Giunto alla nostra osservazione, lamentava parestesie agli arti inferiori, e, all’esame obiettivo, si notava una netta iporeflessia achillea, e modica ipoestesia distale globale. L’esame elettrografico evidenziava un quadro di neuropatia, sia agli arti superiori che inferiori, sensori-motoria, compatibile con un quadro di prevalente assonopatia. Non vi erano, anamnesticamente, altre possibili cause di neuropatia: gli esami bioumorali erano nella norma. Dopo la sospensione della terapia con Amitriptilina, si assisteva ad una graduale normalizzazione del quadro clinico e dei parametri elettrografici investigati. Questa segnalazione vuole puntualizzare il possibile rischio, anche se non frequente, di neurotossicità sul S.N.P., di un farmaco di largo impiego, e giudicato di solito innocuo sotto questo profilo.

     

Peripheral neuropathy in the hypereosinophilic syndrome: a case report

We observed a patient with the hypereosinophilic syndrome that showed as a prominent clinical feature peripheral nerve dysfunction. The neuropathy evolved over 4 months and affected sensory and motor functions. Nerve conduction studies and EMG were compatible with axonal neuropathy. Nerve and muscle biopsies revealed severe axonal degeneration with neurogenic atrophy of muscle. Morphometry of peroneal nerve showed marked axonal loss, more prominent in large myelinated fibers. There was no evidence of vasculitis process. Neuropathy is produced by eosinophil-released substances exerting a neurotoxic effect through direct altered vascular endothelial permeability and local mast cell histamine release.     

汞中毒性周围神经病四例报告

汞中毒性周围神经病在临床上较为少见，有时因病史了解不详或症状不典型，易造成误诊或漏诊，我们自1994年至2005年共收治4例汞中毒性周围神经病病例，现报告如下。