Leprosy Mailing List – February 16, 2021
Ref.: (LML) d.d. pure neuritic leprosy and diabetic neuropathy
From: Wim van Brakel, Amsterdam, the Netherlands
Dear Pieter,
I agree with the points raised by Wim Theuvenet (LML, February 14, 2021).
One other addition from my days of research sensory impairment and sensory in leprosy. Sensory impairment in diabetes tends to be 'deep'. I.e., it also impairs 'deep' sensibility such as vibration sense when tested with a tuning fork or vibrameter on a bony prominence like the ankle. In leprosy, this was rarely impaired.
We did find impaired vibration sense in soft tissue like the finger pulp or toe pulp in a minority of patients (Van Brakel et al, Leprosy Review 1994; Van Brakel et al, PLoS NTD 2008), but most of these patients still felt vibration through bone conduction. Although not likely to be fool proof, this may be a quick way to distinguish the two neuropathies in patients who have bilateral sensory impairment.
Kind regards,
Wim van Brakel
Medical Director NLR
Wim van Brakel
Medical Director
W.vanBrakel@nlrinternational.org
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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