1922. No. 16. THE NEUROLOGICAL ASPECT OF LEPROSY. g 



and there are a great many cases where it is impossible to make the 

 diagnosis from the cutaneous lesions alone, The cutaneous manifestations 

 may thus be quite like vitiligo (cpr. Jeanselme, Blum's and Terri's „Dy- 

 schromies lépreuses"). In some few cases marked skin disturbances seem 

 never to have developed; at any rate there is a number of cases where 

 cutaneous manifestations have never been observed by the patients — nor 

 by the doctor at the first consultations. 



From what is mentioned above it will be seen that a thorough examina- 

 tion for nerve lesions is of the utmost importance for the diagnosis of 

 lepros}', — in a great many cases the neurological examination is the decisive 

 factor — in some cases it furnishes the only findings upon which the diag- 

 nosis can be based. In every case, therefore, where the suspicion of 

 leprosy arises, a systematic neurological examination ought to be carried out. 



In this book it has been my aim to put together my clinical findings, 

 thus attempting to give a complete clinical picture of the neurological aspect 

 of lepros}'.^ For the sake of orientation I have included a short chapter 

 on the pathological anatomy of the nervous lesions in leprosy; but this is 

 onlv meant as a short survey. 



2. Pathological Anatomy of the Nervous Lesions in Leprosy. 



Already in the descriptions of the first Norwegian authors, Danielsen 

 and BoEK, the leprous neuritis is mentioned, and the anatomy of the leprous 

 affections of the nervous system has since then been studied and described 

 by a great number of authors (Virchow, Armauer Hansen, Loft, Lie, 

 Déjérine, Leloir, Pierre Marie, Jeanselme, Gerlach, Dehio, and many 

 others). The nature of the neuritis has been the subject of considerable 

 discussion. It has partly been regarded as an ascending neuritis — and 

 based on this view Dehio constructed his diagram, which in a particularly 

 lucid way illustrates the supposed connection between the cutaneous patches, 

 the neuritis, and the motor and sensory disturbances (cpr. Fig. i). 



The neuritis has also been regarded as descending and partly also as 

 metastatic. Probably all three forms of neuritis ma}' exist, the ascending form 

 however being the commonest. The descending form seems to be exceptional 

 (Lie). As regards the distribution, it must further be remembered that in 

 the course of each nerve one generally finds a locus minoris resistentiae, 

 where the anatomical changes are often excessive. Such a locus minoris 

 resistentiae is found in the course of the ulnar nerve behind the elbow 



' As regards the technique of the clinical examination the reader is referred to my book : 

 The Clinical Examination of the Nervous System (2d. edition, Lewis & Co., London 1923). 



