{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:39:51Z","timestamp":1780090791034,"version":"3.54.0"},"reference-count":27,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,3]]},"abstract":"<jats:p>Neurotropism and infiltration by <jats:italic>Mycobacterium leprae<\/jats:italic> of peripheral nerves causing neuropathy are well established, but reports of central nervous system (CNS) damage are exceptional. We report CNS magnetic resonance imaging (MRI) abnormalities of the brain and spinal cord as well as lesions in nerve roots and plexus in leprosy patients. Eight patients aged between 17 and 41 years underwent detailed clinical, histopathological, and MRI evaluation. All had prominent sensory\u2013motor deficits with hypopigmented and hypo\/anesthetic skin patches and thickened peripheral nerves. All demonstrated <jats:italic>M. Leprae<\/jats:italic> DNA in affected peripheral nerve tissue. All received multidrug therapy (MDT). Two patients had brainstem lesions with enhancing facial nuclei and nerves, and one patient had a lesion in the nucleus ambiguus. Two patients had enhancing spinal cord lesions. Follow-up MRI performed in four cases showed resolution of brainstem and cord lesions after starting on MDT. Thickened brachial and lumbosacral plexus nerves were observed in six and two patients, respectively, which partially resolved on follow-up MRI in the two cases who had reimaging. The site and side of the MRI lesions corresponded with the location and side of neurological deficits. This precise clinico-radiological correlation of proximal lesions could be explained by an immune reaction in the gray matter corresponding to the involved peripheral nerves, retrograde axonal and gray matter changes, or infection of the CNS and plexus by lepra bacilli. Further study of the CNS in patients with leprous neuropathy is needed to establish the exact nature of these CNS MRI findings.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0945","type":"journal-article","created":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T07:02:10Z","timestamp":1549954930000},"page":"921-931","source":"Crossref","is-referenced-by-count":31,"title":["Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging\u2013Based Study"],"prefix":"10.4269","volume":"100","author":[{"given":"Kiran","family":"Polavarapu","sequence":"first","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"},{"name":"Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veeramani","family":"Preethish-Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"},{"name":"Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seena","family":"Vengalil","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saraswati","family":"Nashi","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallika","family":"Lavania","sequence":"additional","affiliation":[{"name":"Stanley Browne Research Laboratory, The Leprosy Mission, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajari","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Mahadevan","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thagadur Chickabasaviah","family":"Yasha","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitender","family":"Saini","sequence":"additional","affiliation":[{"name":"Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utpal","family":"Sengupta","sequence":"additional","affiliation":[{"name":"Stanley Browne Research Laboratory, The Leprosy Mission, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumyla","family":"Jabeen","sequence":"additional","affiliation":[{"name":"Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bevinahalli N.","family":"Nandeesh","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itu","family":"Singh","sequence":"additional","affiliation":[{"name":"Stanley Browne Research Laboratory, The Leprosy Mission, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niranjan P.","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chevula","family":"Pradeep-Chandra-Reddy","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth J.","family":"Parry","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. John\u2019s Medical College, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atchayaram","family":"Nalini","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"464","article-title":"Leprosy now: epidemiology, progress, challenges, and research gaps","volume":"11","author":"Rodrigues","year":"2011"},{"key":"b2","series-title":"Int Health","first-page":"77","article-title":"Nerve damage in leprosy: a continuing challenge to scientists, clinicians and service providers","volume":"4","author":"Lockwood","year":"2012"},{"key":"b3","first-page":"317","volume":"87","author":"World Health Organization","year":"2012"},{"key":"b4","series-title":"Open Forum Infect Dis","first-page":"ofw063","article-title":"Delayed diagnosis, leprosy reactions, and nerve injury among individuals with Hansen\u2019s disease seen at a United States clinic","volume":"3","author":"Leon","year":"2016"},{"key":"b5","series-title":"Neurol India","first-page":"427","article-title":"Spinal cord involvement and ganglionitis in 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I. Distribution of para-rosanilin positive materials in leprosy with special relation to tissue injury [in Japanese]","volume":"53","author":"Yamada","year":"1984"},{"key":"b15","series-title":"J Med Microbiol","first-page":"115","article-title":"Detection of antibodies against phenolic glycolipid-1 (PGL-1), 35-kDa and 30-40-kDa components of Mycobacterium leprae in the cerebrospinal fluid of of leprosy patients","volume":"43","author":"Patil","year":"1995"},{"key":"b16","series-title":"Indian J Lepr","first-page":"813","article-title":"Central nervous system involvement in leprosy","volume":"56","author":"Katoch","year":"1984"},{"key":"b17","series-title":"Indian J Lepr","first-page":"1","article-title":"A clinical study of the involvement of cranial nerves in leprosy","volume":"76","author":"Gopinath","year":"2004"},{"key":"b18","series-title":"Lepr India","first-page":"133","article-title":"The spinal cord, peripheral nerves and the skin patches of leprosy macules","volume":"24","author":"Woit","year":"1952"},{"key":"b19","series-title":"Int J Lepr","first-page":"325","article-title":"Studies on leprosy. I. The central, sympathetic and peripheral nervous systems","volume":"4","author":"Ermak\u00f3va","year":"1936"},{"key":"b20","series-title":"Nihon Rai Gakkai Zasshi","first-page":"27","article-title":"Pathology of spinal cord in leprosy [in Japanese]","volume":"48","author":"Koya","year":"1979"},{"key":"b21","series-title":"Lepr India","first-page":"623","article-title":"A study of continuous bacillaemia in borderline and lepromatous type of leprosy","volume":"54","author":"Raval","year":"1982"},{"key":"b22","series-title":"Int J Lepr Other Mycobact Dis","first-page":"94","article-title":"Visceral lesions in lepromatous leprosy. Study of sixty necropsies","volume":"41","author":"Bernard","year":"1973"},{"key":"b23","series-title":"Arch Pathol Lab Med","first-page":"182","article-title":"Hepatic granulomas in leprosy. Their relation to bacteremia","volume":"100","author":"Chen","year":"1976"},{"key":"b24","series-title":"Am J Clin Pathol","first-page":"797","article-title":"Nongranulomatous involvement of the bone marrow in lepromatous leprosy","volume":"92","author":"Suster","year":"1989"},{"key":"b25","series-title":"J Korean Soc Peripher Nerv Syst","first-page":"1","article-title":"Brachial plexus injury in adults","volume":"3","author":"Park","year":"2017"},{"key":"b26","series-title":"J Clin Rheumatol","first-page":"432","article-title":"Leprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease","volume":"17","author":"Simeoni","year":"2011"},{"key":"b27","series-title":"Ann Intern Med","first-page":"423","article-title":"Serum angiotensin-converting enzyme in leprosy and coccidioidomycosis","volume":"87","author":"Lieberman","year":"1977"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/100\/4\/article-p921.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/100\/4\/article-p921.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/100\/4\/article-p921.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T20:57:37Z","timestamp":1722459457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/100\/4\/article-p921.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,3]]},"references-count":27,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0945","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,3]]}}}