02392nas a2200241   4500000000100000008004100001260001200042653002500054653002100079653001200100653001300112100001100125700001300136700001300149700001200162700001200174700001300186700001200199700001500211245013300226520177700359022001402136       2023                            d  c10/202310aMycobacterium leprae10aHansen's disease10aleprosy10aMyelitis1 aGarg R1 aUniyal R1 aPandey S1 aTejan N1 aRizvi I1 aSharma P1 aKumar N1 aMalhotra H00aThe spectrum of central nervous system manifestations in leprosy: a systematic review of published case reports and case series.3 a<p><strong>Background: </strong>This systematic review aimed to investigate central nervous system (CNS) involvement in leprosy by analysing multiple cohort studies, individual cases and case series.</p>

<p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed, Scopus and Embase databases were searched up to 8 July 2023, using a predefined search strategy. Inclusion criteria included patients diagnosed with leprosy with evidence of CNS involvement. The quality of the included cases was evaluated using the Joanna Briggs Institute checklist.</p>

<p><strong>Results: </strong>A total of 34 records were identified, including 18 cohort studies and 16 reports describing 27 isolated cases. Autopsies revealed macroscopic changes in the spinal cord, neurofibrillary tangles and senile plaques. Mycobacterium leprae was detected in neurons of the medulla oblongata and spinal cord using PCR and phenolic glycolipid 1 staining. Cerebrospinal fluid (CSF) analysis showed inflammatory changes, increased gamma globulins and detection of Mycobacterium leprae antigens and antibodies. In 21 patients (78%), spinal cord/brachial plexus abnormities were detected. In the majority, MRI revealed T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity in the cervical cord. In patients with brainstem involvement, T2/FLAIR hyperintensity was noted in the cerebellar peduncles, facial nerve nuclei and/or other cranial nerve nuclei. Brain parenchymal involvement was noted in three patients.</p>

<p><strong>Conclusions: </strong>This systematic review provides evidence of CNS involvement in leprosy, based on autopsy findings, neuroimaging, CSF analysis and neurophysiological studies.</p>
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