Evaluation of S-100 immunostaining in the demonstration of nerve changes in tuberculoid and borderline tuberculoid leprosy - A descriptive, prospective and retrospective analytical study

S-100 immunohistochemical staining may detect nerve involvement in early stages of tuberculoid spectrum of leprosy. This study investigated the use of S-100 in early diagnosis of the tuberculoid and borderline tuberculoid leprosy and compared its sensitivity with hematoxylin and eosin (HE) stains in discerning the nerve involvement. To study the different histopathological patterns of nerve involvement in tuberculoid and borderline tuberculoid leprosy on S-100 immunostaining and also to compare the sensitivity of HE stain with S-100 immunostain in discerning the nerve involvement in these cases. This was a descriptive, prospective and retrospective analytical study, which included patients with tuberculoid spectrum of leprosy. Histopathological examination (HPE) and immunohistochemical (IHC) analysis were performed on all skin biopsies using HE stain and S-100 immunostain, respectively. Then the sensitivities of both the stains in discerning the nerve involvement were calculated and the data was analyzed using SPSS software version 22 by applying chi-square test. The study included a total of 58 patients [tuberculoid (n=28), borderline tuberculoid (n=30)]. The mean age was 43 yrs. The most common clinical manifestation was hypopigmented patches (n=40, 70%) with loss of sensation (n=39, 68.3%). HPE revealed 36 cases with well-defined granulomas, 22 cases with ill-defined granulomas and 41 cases with nerve destruction. IHC analysis showed four different patterns of nerve damage (fragmented, n=32; infiltrated and fragmented, n=14; infiltrated, n=10; intact, infiltrated and fragmented; n=1). The sensitivity and positive predictive value (PPV) of HE staining in delineating the nerve involvement were 68.96% and 100%, respectively. Whereas, the sensitivity and PPV of S-100 IHC were 100% each. Less number of cases. Use of S-100 IHC along with HPE aids in early, accurate and confirmatory diagnosis.

Pterygopalatine Fossa: A Way to Spread Mucormycosis with Multiple Cranial Nerve Involvement

Background: Mucormycosis is a rare, aggressive, and fatal infection caused by fungi of the Mucorales order of Zygomycete fungi. Mucormycosis is mainly found in patients with chronic conditions, and clinical cases are observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Rhinocerebral type is the most prevalent type of mucormycosis which has a characteristic method of spread. Although the involvement of cranial nerves is not common, it can be multiple with facial nerve involvement. Case Presentation: We described an unusual route of fungus spread in a 50-year-old woman with the involvement of many cranial nerves, without obvious necrosis or significant involvement of paranasal sinuses. Pterygopalatine fossa was a way to spread mucormycosis. Conclusion: In every diabetic patient with cranial nerve palsy and sinusitis, invasive mucormycosis must be considered.

COVID-19 associated cranial nerve neuropathy: A systematic review

The involvement of cranial nerves is being increasingly recognised in COVID-19. This review aims to summarize and discuss the recent advances concerning the clinical presentation, pathophysiology, diagnosis, treatment, and outcomes of SARS-CoV-2 associated cranial nerve mononeuropathies or polyneuropathies. Therefore, a systematic review of articles from PubMed and Google Scholar was conducted. Altogether 36 articles regarding SARS-CoV-2 associated neuropathy of cranial nerves describing 56 patients were retrieved. Out of these 56 patients, cranial nerves were compromised without the involvement of peripheral nerves in 32 of the patients, while Guillain-Barre syndrome (GBS) with cranial nerve involvement was described in 24 patients. A single cranial nerve was involved either unilaterally or bilaterally in 36 patients, while in 19 patients multiple cranial nerves were involved. Bilateral involvement was more prevalent in the GBS group (n=11) as compared to the cohort with isolated cranial nerve involvement (n=5). Treatment of cranial nerve neuropathy included steroids (n=18), intravenous immunoglobulins (IVIG) (n=18), acyclovir/valacyclovir (n=3), and plasma exchange (n=1). The outcome was classified as “complete recovery” in 21 patients and as ”partial recovery” in 30 patients. One patient had a lethal outcome. In conclusion, any cranial nerve can be involved in COVID-19, but cranial nerves VII, VI, and III are the most frequently affected. The involvement of cranial nerves in COVID-19 may or may not be associated with GBS. In patients with cranial nerve involvement, COVID-19 infections are usually mild. Isolated cranial nerve palsy without GBS usually responds favorably to steroids. Cranial nerve involvement with GBS benefits from IVIG.

Prevalence of Nerve Dysfunction in Individuals in Satara District Suffering from Chronic Neck Pain - A Nerve Conduction Velocity Study

BACKGROUND Chronic neck pain is one of the common and painful musculoskeletal conditions. Determining the prevalence of nerve impairment in chronic neck pain patients is faced with various challenges such as individual perception and coping patterns of pain and likelihood to seek and receive treatment. We wanted to determine the prevalence of nerve impairment in patients of chronic neck pain and estimate the occupation, age, and gender wise involvement of nerve impairment in chronic neck pain patients. METHODS Population in and around Karad diagnosed with chronic neck pain by an orthopaedician fulfilling the inclusion criteria with prior consent were taken for the study. In the first half of the study, participants were assessed based on a questionnaire and a clinical assessment using Upper Limb Tension Tests following which the participants were assessed using nerve conduction velocity studies. RESULTS Participants having chronic neck pain and showing nerve dysfunctions were 32.14 %. Based on F min, frequency of nerve dysfunction within age groups showed the highest percentage that was 10.72 % in the age group of 39 - 42 years. Higher involvement was observed in males than females which was 23.21 %. Occupation wise nerve involvement for nerve dysfunction showed physically demanding occupations which had higher percentage of 14.28 %. CONCLUSIONS This study shows large population of chronic neck pain with no symptoms of nerve involvement but having nerve dysfunction and were not receiving any treatment for their condition thereby allowing it to progress into a radiculopathy. KEY WORDS Chronic Neck Pain, NCV Study, Cervical Radiculopathy, F Min Latency

Retinopathies with Phacomatoses; Pathophysiology, Findings, Diagnosis and Treatment (Von Hippel-Lindau Disease, Tubular Sclerosis, Neurofibromatosis)

Phacomatosis is the general name for a group of diseases (Neurofibromatosis 1 (NF-1), Neurofibromatosis 2 (NF-2), Von Hippel Lindau, tuberous sclerosis, ataxia-telangiectasia, and Sturge Weber syndrome) that include different clinical syndromes characterized by eye, skin, neurological and oncological symptoms. They are formed as a result of tumor suppressor protein loss, which controls the abnormal growth of cells. Most of these diseases are autosomal dominant. Neurofibromatosis -1 is the most common type of phacomatosis. autosomal dominant passes. Skin (cafe au-lait = milk coffee stain, armpit, and inguinal freckles), ocular involvement, and nerve involvement (neurofibromas) are seen. In NF-2, in addition to NF-1, 8th cranial nerve involvement is present. In ocular involvement of neurofibromatosis, proptosis, strabismus, pulsatile exophthalmos, ptosis may occur due to neurofibromas. Hamartomas in iris (lisch nodules), posterior subcapsular cataract (more often in NF-2), retinal astrocytic hamartomas, and optic glioma can be seen. Von Hippel Lindau passes autosomal dominant. Brain (cerebellum) spinal cord, renal cell carcinoma, pheochromocytoma, pancreatic neuroendocrine tumors, and renal or pancreatic cysts may occur as systemic involvement. Retinal hemangioblastomas can be seen in ocular involvement. Tuberous sclerosis passes autosomal dominantly. It is a disease in the group of phacomatosis, characterized by hamartomas affecting more than one organ, including the skin, central nervous system, lung, heart, and kidney. Multiple astrocytic hamartomas can be seen in ocular involvement. In conclusion, when these lesions are seen in the eyes, it is necessary to treat them with a multidisciplinary approach considering that systemic involvement may occur.