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Cervical perineurial cyst, a red herring (case report).
S K Bansal1, U K Dhand, N Khandelwal
1Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Summary
Leprosy can affect nerves without typical skin changes. This case highlights how leprotic ulnar mononeuropathy was diagnosed after initial misattribution to cervical cysts.
Area of Science:
- Neurology
- Infectious Diseases
- Dermatology
Background:
- Leprosy (Hansen's disease) can manifest with neurological complications.
- Mononeuropathy, affecting a single nerve, is a known presentation of leprosy.
- Maculoanesthetic patches are common but not universal signs of leprosy.
Observation:
- A patient presented with right hand wasting, initially suspected to be C8-T1 entrapment radiculopathy from cervical perineurial cysts.
- The perineurial cysts were deemed benign, and ulnar nerve thickening was questionable.
- A trial of anti-leprosy medication was initiated based on clinical suspicion.
Findings:
- Clinical and electrophysiological evaluations ultimately supported a diagnosis of leprotic ulnar mononeuropathy.
- The case demonstrates that leprosy can mimic other neurological conditions.
- Absence of typical skin lesions does not exclude leprosy.
Implications:
- This case underscores the importance of considering leprosy in the differential diagnosis of unexplained mononeuropathy, even without characteristic skin findings.
- Early and accurate diagnosis of leprotic neuropathy is crucial for effective treatment and preventing further nerve damage.
- Clinicians should maintain a high index of suspicion for leprosy in endemic areas or in patients with relevant exposure history.