Cerebrospinal fluid analysis in 58 ruminants showing neurological disorders / Análise do líquido cefalorraquidiano em 58 ruminantes com distúrbios neurológicos

Ruminants may be affected by a wide variety of central nervous system (CNS) diseases. Cerebrospinal fluid (CSF) analysis forms the basis for ante mortem diagnostic evaluation of ruminants with clinical signs involving the CNS. Despite its importance as a tool to aid diagnosis, data regarding CSF examinations in spontaneous cases of CNS diseases in ruminants from Brazil are limited, and most reports involve experimental studies. Therefore, this study aimed to report the results of CSF analysis in 58 ruminants showing signs of neurological disorders. CSF samples for analysis were obtained from 32 cattle, 20 sheep, and 6 goats by cerebello-medullary cistern (n=54) or lumbosacral space (n=4) puncture. These ruminants showed neurological signs related to viral (n=13), mycotic (n=3), or bacterial (n=15) infections, and toxic (n=21), traumatic (n=4), or congenital disorders (n=2). CSF analysis from ruminants with viral infections presented lymphocytic pleocytosis, even though CSF showed no changes in several cases of rabies. Neutrophilic pleocytosis, cloudiness, presence of fibrin clots, and abnormal coloration were evident in the CSF of most cases of CNS bacterial infection, such as meningoencephalitis, meningitis, abscesses, myelitis, and a case of conidiobolomycosis. On the other hand, CSF was unchanged in most cases of toxic disorders, as botulism and hepatic encephalopathy. Elevated CSF density was observed in 60% of ruminants diagnosed with polioencephalomalacia. Our findings show that evaluation of CSF is a valuable diagnostic tool when used in association with epidemiological, clinical and pathological findings for diagnosis of CNS diseases in ruminants.(AU)

Os ruminantes podem ser afetados por uma grande variedade de doenças do sistema nervoso central (SNC). A análise do líquido cefalorraquidiano (LCR) constitui a base da avaliação diagnóstica ante mortem de ruminantes com sinais clínicos envolvendo o SNC. Apesar de sua importância como ferramenta para auxiliar no diagnóstico, os dados referentes aos exames do LCR em casos espontâneos de doenças do SNC em ruminantes no Brasil são limitados, e, a maioria dos relatos envolve estudos experimentais. Portanto, este trabalho teve como objetivo relatar os resultados da análise do LCR em 58 ruminantes com distúrbios neurológicos. Amostras do LCR foram obtidas de 32 bovinos, 20 ovinos e 6 caprinos por punção da cisterna cerebelo-medular (n=54) ou espaço lombossacro (n=4) para posterior análise. Esses ruminantes apresentaram sinais neurológicos relacionados a infecções virais (n=13), micóticas (n=3) ou bacterianas (n=15), e desordens tóxicas (n=21), traumáticas (n=4) ou congênitas (n=2) A análise do LCR de ruminantes com infecções virais apresentou pleocitose linfocítica, embora, em vários casos de raiva, o LCR não tenha apresentado alterações. Pleocitose neutrofílica, turbidez, presença de coágulos de fibrina e coloração anormal foram evidentes no LCR da maioria dos casos de infecções bacterianas do SNC, como meningoencefalites, meningites, abscessos, mielite e um caso de conidiobolomicose. Por outro lado, o LCR não foi alterado na maioria dos casos dos distúrbios tóxicos, como botulismo e encefalopatia hepática. A densidade elevada no LCR foi observada em 60% dos ruminantes diagnosticados com polioencefalomalácia. Nossos resultados mostram que a avaliação do LCR é uma valiosa ferramenta de diagnóstico, quando usada em associação com os achados epidemiológicos, clínicos e patológicos para o diagnóstico de doenças do SNC em ruminantes.(AU)

Pericyte loss and detachment in experimental cisplatin-induced neuropathy / Pérdida y desprendimiento de pericitos en la neuropatía experimental inducida por cisplatino

Cisplatin is an antineoplastic agent with neuropathy as one of its major side effect. However, effective treatment is lacking. Increasing evidence suggests that cisplatin might damage nerve capillaries leading to impaired functions of blood-nerve barrier (BNB) and neuropathy. This study was aimed to examine the effects of cisplatin on pericytes. Rats were either treated with intraperitoneal injection of cisplatin 2 mg/kg twice a week for five continuous weeks. Cisplatin-treated rats showed reduced body weight, thermal hypoalgesia and slow sciatic motor nerve conduction velocity, indicating neuropathy. The density of pericytes in the distal sciatic nerves determined by immunohistochemistry to desmin was significantly reduced in the cisplatin compared with that of the control groups. Electron microscopic analysis demonstrated the detachment of pericytes from endothelial cells including the disruption of shared basement membrane in the sciatic nerves from cisplatin-treated rats. These data indicate the pericyte loss and detachment caused by cisplatin. Future studies of the BNB components and functions after cisplatin treatment are needed and will be essential for the development of effective treatments against cisplatin-induced neuropathy.

El cisplatino es un agente antineoplásico y presenta como uno de sus principales efectos secundarios, la neuropatía. Sin embargo, falta un tratamiento eficaz. La creciente evidencia sugiere que el cisplatino podría dañar los capilares nerviosos, lo que puede provocar una alteración de las funciones de la barrera hematoencefálica (BHE) y neuropatía. Este estudio tuvo como objetivo examinar los efectos del cisplatino en los pericitos. Las ratas se trataron con inyección intraperitoneal de cisplatino (2 mg/kg) dos veces por semana durante 5 semanas seguidas. Las ratas tratadas con cisplatino mostraron una reducción del peso corporal, hipoalgesia térmica y una velocidad de conducción del nervio ciático lenta, lo que indicaría neuropatía. La densidad de los pericitos en los nervios ciáticos distales determinada por inmunohistoquímica para desmina se redujo significativamente en el grupo cisplatino en comparación con la de los grupos controles. El análisis al microscopio electrónico demostró el desprendimiento de pericitos de las células endoteliales, incluida la ruptura de la membrana basal compartida en los nervios ciáticos de ratas tratadas con cisplatino. Estos datos indican la pérdida de pericitos y el desprendimiento causado por el cisplatino. Se necesitan estudios futuros de los componentes y funciones del BHE después del tratamiento con cisplatino y serán esenciales para el desarrollo de tratamientos efectivos contra la neuropatía inducida por el cisplatino.

Aberrant Origin of Vertebral Artery and its Clinical Implications

Abstract Aberrant origin of vertebral artery is rare. The anatomical features and clinical significance of this lesion remain to be clarified. A comprehensive collection of the pertinent literature resulted in a cohort of 1286 cases involving 955 patients and 331 cadavers. There were more left than right and more unilateral than bilateral aberrant vertebral arteries. Patients with aberrant origin of vertebral artery were often asymptomatic and in only 5.5% of the patients their symptoms were probably related to the aberrant origin of vertebral artery. The acquired cardiovascular lesions were present in 9.5% of the patients, 20.9% of which were vertebral artery-associated lesions. Eight (0.8%) patients had a vertebral artery dissection. Logistic regression analysis showed significant regressions between bovine trunk and left vertebral artery (P=0.000), between the dual origins of vertebral artery and cerebral infarct/thrombus (P=0.041), between associated alternative congenital vascular variants and cervical/aortic dissection/atherosclerosis (P=0.008). Multiple logistic regression demonstrated that side of the aberrant origin of vertebral artery (left vertebral artery) (P=0.014), arch branch pattern (direct arch origin) (P=0.019), presence of the common trunk (P=0.019), associated acquired vascular disorder (P=0.034) and the patients who warranted management (P=0.000) were significant risk predictors for neurological sequelea. The patients with neurological symptoms and those for neck and chest operations/ interventions should be carefully screened for the possibility of an aberrant origin of vertebral artery. The results from the cadaver metrology study are very helpful in the design of the aortic stent. The arch branch pattern has to be taken into consideration before any maneuver in the local region so as to avoid unexpected events in relation to aberrant vertebral artery.

Shock, diaschisis and von Monakow / Choque, diasquise e von Monakow

The concept of shock apparently emerged in the middle of the 18th century (Whyett) as an occurrence observed experimentally after spinal cord transection, and identified as "shock" phenomenon one century later (Hall). The concept was extended (Brown-Séquard) and it was suggested that brain lesions caused functional rupture in regions distant from the injured one ("action à distance"). The term "diaschisis" (von Monakow), proposed as a new modality of shock, had its concept broadened, underpinned by observations of patients, aiming at distinguishing between symptoms of focal brain lesions and transitory effects they produced, attributable to depression of distant parts of the brain connected to the injured area. Presently, diaschisis is related mainly to cerebrovascular lesions and classified according to the connection fibers involved, as proposed by von Monakow. Depression of metabolism and blood flow in regions anatomically separated, but related by connections with the lesion, allows observing diaschisis with neuroimaging.

O conceito de choque aparentemente surgiu em meados do século 18 (Whyett), como ocorrência observada experimentalmente após seção transversa da medula, e foi identificado como fenômeno de "choque" um século mais tarde (Hall). O conceito foi estendido (Brown-Séquard) e sugeriu-se que lesões cerebrais produziam ruptura funcional em regiões distantes à da lesão ("action à distance"). O termo "diásquise" (von Monakow), proposto como nova modalidade de choque, teve seu conceito ampliado, fundamentado em observações em pacientes. Visava distinguir sintomas de lesões cerebrais focais de efeitos transitórios que produziam, atribuíveis à depressão de partes distantes do cérebro conectadas à área lesada. Atualmente, diásquise é relacionada principalmente a lesões cerebrovasculares e classificada de acordo com as fibras de conexão envolvidas, como proposto por von Monakow. Depressão do metabolismo e fluxo sanguíneo em regiões anatomicamente separadas, mas relacionadas por conexões à lesão, permitem observar diásquise por meio de neuroimagem.

Sinquinesis óculomotora: dos casos de pacientes excepcionales / Oculomotor synkinesis: two cases excepcional patients

Las sinquinesis son movimientos simultáneos o coordinados en secuencia de mivimientos de músculos suplidos por diferentes nervios o por ramas independientes del mismo nervio que ocurren luego de la recuperación de una lesión axonal periferica; son debidos a la dirección errónea ("misdirection") que toman algunos axones hacia otros músculos que no constituyen su objetivo o blanco; así, cuando el paciente intenta mover algunos músculos, ocurren contracciones involuntarias en otros, no esperadas anatómicamente. Es una suerte de recableado mal realizado y confuso. En las dos pacientes que constituyen nuestro informe, ocurrieron alteraciones óculomotoras excepcionales. En la primera de 60 años portadora de un aneurisma gigante del senocavernoso izquierdo, la sinquinesis nerviosa aberrante ocurrió entre los nervios craneales tercero y sexto. En la segunda de 22 años a quien se resecó un osteocondroma gigante de la fosa media derecha, desarrolló una parálisis total del tercer nerviocraneal con sinquinesis trigémino-oculomotora entre el músculo pterigoideo derecho y el elevador del párpado superior; así como también entre el tercero (recto inferior) y sexto nervios (recto externo) ipsolateral. Se revisa la literatura al respecto.

Synkinesis are simultaneous or coordinated sequential movements of muscles that are supplied by different nerves or have independent nerve branches. They occur after the recovery a peripheral axonal injury. They are due to axons taking a wrong direction ("misdirection") towards muscles that do not constitute their objetives or targets. Thus, when the patient attempts to move a muscle, other muscles show anatomically unexpected involuntary contractions. It is a sort of confusing rewiring. Our report is based on the exceptional oculomotor alterations that occurred in two patients. In the first patient, a 60 years-old female carrying a giant aneurysm of the left cavernous sinus, the aberrant nerve synkinesis ocurred between the third and sixth cranial nerves. In the second patient, a 22 year-old female to whom was resected a giant osteochondroma of the right middle fossa, developed a total paralysis of the third cranial nerve with trigeminal oculomotor synkinesis between the right pterygoid muscle and the elevator of the upper eyelid; as well as between the inferior rectus and ipsilateral external rectus. We review the literature on the subject.

Cheiro-Oral Syndrome: A Clinical Analysis and Review of Literature

PURPOSE: After a century, cheiro-oral syndrome (COS) was harangued and emphasized for its localizing value and benign course in recent two decades. However, an expanding body of case series challenged when COS may arise from an involvement of ascending sensory pathways between cortex and pons and terminate into poor outcome occasionally. MATERIALS AND METHODS: To analyze the location, underlying etiologies and prognosis in 76 patients presented with COS collected between 1989 and 2007. RESULTS: Four types of COS were categorized, namely unilateral (71.1%), typically bilateral (14.5%), atypically bilateral (7.9%) and crossed COS (6.5%). The most common site of COS occurrence was at pons (27.6%), following by thalamus (21.1%) and cortex (15.8%). Stroke with small infarctions or hemorrhage was the leading cause. Paroxysmal paresthesia was predicted for cortical involvement and bilateral paresthesia for pontine involvement, whereas crossed paresthesia for medullary involvement. However, the majority of lesions cannot be localized by clinical symptoms alone, and were demonstrated only by neuroimaging. Deterioration was ensued in 12% of patients, whose lesions were large cortical infarction, medullary infarction, and bilateral subdural hemorrhage. CONCLUSION: COS arises from varied sites between medulla and cortex, and is usually caused by small stroke lesion. Neurological deterioration occurs in 12% of patients and relates to large vessel occlusion, medullary involvement or cortical stroke. Since the location and deterioration of COS cannot be predicted by clinical symptoms alone, COS should be considered an emergent condition for aggressive investigation until fatal cause is substantially excluded.

Neurological manifestations of Behcet's disease

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcets disease. This prospective study was carried out in the Behcets Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet s patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet s Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcets disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies

Ischemic monomelic neuropathy: a complication of vascular access procedure

Ischemic monomelic neuropathy [IMN] is an infrequently recognized type of ischemic neuropathy produced by shunting of blood or due to acute noncompressive occlusion of the major proximal limb artery. Most reports about this complication appear in the neurology literature. IMN predominantly occurs in diabetic patients with evidence of peripheral neuropathy and atherosclerotic peripheral vascular disease. We report a case of ischemic monomelic neuropathy occurring in a patient with end stage diabetic nephropathy following PTFE [polytetrafluoroethylene] graft placement in proximal upper limb for chronic maintenance hemodialysis

Neurologic Complications of Human Immunodeficiency Virus-type 1 Infection

A wide variety of neurologic complications associated with human immunodeficiency virus-type 1 (HIV-1) infection result from HIV-1 itself or secondarily related to immunosuppression. In Korea, the number of HIV-1 seropositive populations is increasing, but little has been known about the neurologic complications of HIV-1 infection. To investigate the neurologic complications in HIV-1 infected Korean patients, we performed a cross-sectional study in consecutive admissions to the Seoul National University Hospital between March 1998 and June 1999. Thirty-four HIV-1 seropositive patients were included. As a result, a total of 26 HIV-1 related neurologic complications were identified from 17 patients. Among them, 10 patients showed cognitive/motor abnormalities: 3 HIV-1-associated dementia and 7 possible HIV-1-associated minor cognitive/motor disorder. Neuromuscular complications were found in 10 patients: 9 distal symmetric polyneuropathy, and 1 possible chronic inflammatory demyelinating polyradiculoneuropathy. In 3 patients with focal brain lesions, 2 were presumptively diagnosed as having primary CNS lymphoma, and 1 as having progressive multifocal leukoencephalopathy in the posterior fossa, based on history, clinical findings, serology, radiological appearances, and response to empirical therapy. Other complications included cryptococcal meningitis and only soft neurologic signs without any neurologic disease. Most of these complications (88%) occurred in the advanced stage of infection.

Host parasite response in nerve in leprosy.

Nerve granulomas occur at all points across the leprosy spectrum. Studies have been made using experimental models in which mycobacteria were injected directly in the sciatic or posterior tibial nerve of the guinea pig. Clinical and electrophysiological studies demonstrated axonal damage which was confirmed by morphometric studies showing disrupted myelin sheaths and in places complete demyelination. Further immunohistological studies showed a complete disappearance of staining for certain neuropeptides. The role of Schwann cells has also been investigated. Schwann cells in nerves affected by mycobacterial granulomas, both experimental and in leprosy patients were not demonstrated to be MHC class II positive suggesting that they did not play a role in antigen presentation. Macrophages in leprosy granulomas were shown to contain TNF alpha, suggesting that this cytokine played a role in axonal damage. The role of mycobacterial heat-shock protein in nerve granulomas has not as yet been determined. The localized nature of granulomas in leprosy nerves and nerves with experimental mycobacterial granulomas has been studied by a process of excision and repair with muscle grafts. Marked recovery has been demonstrated by clinical, electrophysiological, morphometric and immuno-histochemical techniques, the latter demonstrating a return of neuropeptide production.

Estudio de los anticuerpos antifosfolipido y antiesfingomielina en pacientes con patología neurológica / Study of the antiphospholipid antibodies antiphingomyelin in patients with afferted by neurological pathologies

La investigación se realizó en 100 individuos de uno y otro sexo los cuales fueron divididos en dos grupos: un grupo de 50 individuos clínicamente sanos que se realizó como control y los 50 restantes habían padecido, al momento del muestreo, enfermedades neurológicas tales como accidentes cerebrovascular,cefalea, síndrome de Guillain-Barre y epilepsia. En todos ellos se efectuaron los siguientes análisis: tiempo de protombina diluido 1:3000 (TDP 1:3000) tiempo de tromboplastina activido con Kaolin (PTTK), y pruebas inmunológicas para la detección de anticuerpos antifosfolípido AAP y antiesfingomielina (AAE). Para la determinación de AAP se utilizó el método de redioinmunoensayo en fase sólida micro ELISA y para la determinación del AAE se implementó una modificación de la técnica de radioinmunoensayo que permitía conseguir resultados reproducibles. De acuerdo con esta técnica, se consideraron positivos al AAE los pacientes que presentaban un valor superior al valor promedio de la densidad óptica del grupo control más tres veces la desviación estándar, siendo este valor igual a 0.156. Los análisis se efectuaron en los laboratorios del Banco Municipal de Sangre del Distrito Federal (Caracas) y en el Hospital Central de Maracay. Los resultados obtenidos en los grupos control y paciente se compararon mediante la prueba de "t" de Student. Las pruebas de coagulación TPD 1:3000 y PTTK resultaron normales en el 89 por ciento de los pacientes y no se encontró relación entre estas pruebas y la presencia de los anticuerpos buscados, no apareciendo los anticuerpos antifosfolípido en ninguno de los grupos, mientras que el anticuerpo antiesfingomielina estuvo presente en el 52 por ciento de todos los casos patológicos considerados. En la literatura nacional no se han encontrado trabajos similares al efectuado en pacientes con patologías neurológicas. Investigadores de otros países han reportado la presencia de los anticuerpos antifosfolípido en individuos afectados por lupus eritematoso sistémico.

Skull base surgery in Prasat Neurological Institute.

Skull base technique is very useful for lesions around the base of the skull. Additionally, this technique can replace some standard approaches when the surgeon wants to avoid excessive retraction and needs better visualization. This technique can be used for aneurysms especially a posterior circulation aneurysm which is very difficult by standard microsurgical approach. We employed this technique and total tumor removal was achieved in some cases. We realize that the increasing experience of neurosurgeons, will improve the result. Teamwork as well as cooperation between other surgeons is necessary to get the best result from this kind of surgery.

Neuronal intestinal dysplasia: a role for surgery?

Neuronal intestinal dysplasia (NID) is a poorly understood colonic motility disorder with characteristic histopathological findings and clinical presentation. It is often associated with Hirschsprung's disease (HD) and can constitute a cause of failure of clinical improvement after adequate resectional pull-through surgery. Other conditions associated with NID are: Chronic Intestinal Pseudo-obstruction (CIPO), anorectal malformations and Multiple Endocrine Neoplasia (MEN) II syndrome patients. To increase the diagnostic yield of NID the pathologist should be aware and use histochemistry evaluation of the rectal biopsy specimen in patients with history of constipation or unexplained bouts of diarrhea. Adequate sampling of the temporary proximal colostomy done to HD patients should be examined for NID pathological changes. Treatment has centered around the clinical picture with most cases managed medically with prokinetic agents, colonic irrigations, and bowel cathartics until improvement and normalization of histology occur. There is evidence of progressive maturation of the enteric nervous system with time. Surgery is indicated for patients with severe clinical deterioration after failed medical management

Patogenesis social de las enfermedades neuroinfecciosas

En el servicio de Neurología del Hospital Carlos Andrade Marín durante el año de 1993 fueron hospitalizados 400 pacientes. Se estudió al grupo más importante de patología previsible que es el de las enfermedades infecciosas con 62 pacientes(16 por ciento). De estos, 38 casos (61 por ciento) estuvieron entre los 20 y 49 años, es decir, la edad más productiva. En orden de frecuencia: neurocisticercosis con 28 casos (45 por ciento) y meningitis 22 casos (35 por ciento) fueron los más importantes. En la muestra se invetigó la potancialidad de prevención de la enfermedad en cada paciente mediante cuestionario Standard contestado al ingreso y al alta, sobre conocimientos basicos de salubridad que permitan prevenir la patología infecciosa. Solo un paciente (1.6 por ciento) conoció al ingreso la causa de su enfermedad y cómo prevenirla. el resto: 61 pacientes (98.4 por ciento) no tenían este conocimiento. Al momento del alta ocho pacientes (13 por ciento) conocieron sobre la causa y medidas de prevención respectivas. Se concluye que un importante factor de riesgo para adquirir enfermedades neuro-infecciosas es la pobre educación en salud de nuestra población. Se observa también el incipiente papel que en ella juega la estadía hospitalaria del paciente. Los índices de morbimortalidad descenderán cuando mejore la atención primaria de salud, permitirán un significativo ahorro económico y mayor productividad de la población jóven, hoy fuertemente atacada por enfermedades neuro-infecciosas.

Neurosida: Estudio descriptivo, clinico-paraclinico de 50 pacientes infectados por el VIH / Neurological AIDS: a descriptive, clinical-paraclinical study of 50 patients infected with HIV

Es conocido el elevado neurotropismo del virus de la inmunodeficiencia humana (VIH), tanto en sus manifestaciones clinico-patologicas como paraclinicas. Dichas manifestaciones pueden ser la consecuencia de la agresion directa del virus sobre el SNC y periferico o proporcionar alteraciones inmunitarias que faciliten la aparicion de infecciones o neoplasias. Existen aspectos controvertidos en esta patologia. Con el proposito de aportar informacion acerca de estos aspectos, mas especificamente sobre la patologia por agresion directa del VIH, se estudiaron 50 pacientes infectados con el virus, 27 en estado II - III del CDC, y 23 en estadio IV, realizando un estudio transversal, clinico paraclinico, (EEG, Potenciales evocados multimodales, Estudio electrico periferico, TAC y estudio del LCR citobioquimico e inmunoproteico), comparando posteriormente los hallazgos obtenidos. El estudio ha evidenciado la afectacion precoz del sistema nervioso en la enfermedad, tanto en el area clinica , neuropsicologica, y estudio del LCR (citobioquimico e inmunoproteico), como en los potenciales evocados auditivos y el estudio electrico periferico. Se constata asimismo un deterioro progresivo en el SNC y periferico en las pruebas relacionadas segun los estudios clinicos existiendo una correlacion casi paralela entre el estudio neuropsicologico, el estudio electrico periferico, la TAC y el EEG

Hypopigmented lesions in early leprosy--a clinical and histological study.

26 Patients of leprosy presenting with hypopigmented lesions were divided on morphological grounds into 3 Sub groups, Group I (9 patients) with well-defined single patch with moderate to complete sensory loss; Group II (8 patients) with single ill-defined lesion having partial sensory loss; and Group III (9 patients) having multiple hypo-pigmented patches with mild to moderate sensory loss. Epidermal atrophy was a conspicuous histological finding in all groups. Only patients in Group I showed epitheloid cells in dermal infiltrate with erosion of epidermis in one case. This group may be labelled as maculoanesthetic leprosy. Patients in Group II and III showed mononuclear cell infiltrate in dermis, around neurovascular bundles and appendages. They were histologically consistent with indeterminate leprosy. Follow-up biopsy after six to eight months of treatment showed healing of the lesion of reduction in the infiltrate in most cases.