Copyright © 2014 Elsevier Inc. All rights reserved. Chapter 42 Neurologic Complications of Leprosy Thomas D. Sabin and Thomas R. Swift Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-1 Tuberculoid (TT) leprosy. There is complete anesthesia within this lesion, which has a raised erythematous border and a pale, dry center. (Courtesy of Gillis W. Long Hansen’s Disease Center, Carville, Louisiana.) Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-2 Lepromatous (LL) leprosy. There is infiltration of the cooler facial promontories, such as the ears, upper lip, chin, and supraorbital and malar areas. (Courtesy of Gillis W. Long Hansen’s Disease Center, Carville, Louisiana.) Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-3 Erythema nodosum leprosum. Painful subcutaneous nodules cover the face and trunk (not shown) and the extremities. (Courtesy of Gillis W. Long Hansen’s Disease Center, Carville, Louisiana.) Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-4 Borderline (BB) leprosy. The widespread symmetric skin lesions are hypesthetic. (Courtesy of Gillis W. Long Hansen’s Disease Center, Carville, Louisiana.) Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-5 Sural nerve biopsy, lepromatous leprosy (LL). Acid-fast stain reveals numerous organisms in endoneurial vacuoles. (Courtesy of Gillis W. Long Hansen’s Disease Center, Carville, Louisiana.) Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-6 Lepromatous leprosy (LL). Sensation is diminished in cool zones of the face, trunk, and extremities. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-7 Lepromatous leprosy (LL). Sensation is preserved in warm areas: axillae, palms, antecubital fossae, inguinal region, gluteal cleft, and center of back and chest. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-8 Lepromatous leprosy (LL). Enlargement of the median nerve proximal to the carpal tunnel is shown. (Courtesy of Dr. Paul Brand and Gillis W. Long Hansen’s Disease Center, Carville, Louisiana.) Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-9 Lepromatous leprosy (LL). There is sensory sparing of the scalp, in the axillae and the groin, in the center of the back and the chest, and in the antecubital fossae. Copyright © 2014 Elsevier Inc. All rights reserved.

Copyright © 2014 Elsevier Inc. All rights reserved. Figure 42-10 Borderline leprosy (BB). Sensory loss occurs in the skin lesions. Skin lesions tend to affect cooler areas. Copyright © 2014 Elsevier Inc. All rights reserved.