• View in gallery

    Arrow: Great auricular nerve. Arrow-head: Transverse cervical nerve. L: Left side and R: Right side.

  • View in gallery

    Arrow: Great auricular nerve. Arrow-head: Transverse cervical nerve. L: Left side and R: Right side.

  • View in gallery

    Photomicrograph of sural nerve biopsy showing acid fast bacilli singularly (arrow heads) and in bundles (arrows) (Modified Ziehl-Neelsen stain, 1,000×).

  • 1.

    MacLeod JM, 1911. Case of Maculo-anesthetic Leprosy. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2004861/pdf/procrsmed00985-0016a.pdf. Accessed September 25, 2011.

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  • 2.

    Standring S, 2008. Head and neck. Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, Johnson D, Mahadevan V, Newell RL, Wigley C, eds. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. Fortieth edition. London, UK: Churchill Livingstone, 435466.

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Bilateral Enlargement of Transverse Cervical Nerve in Two Patients of Leprosy

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  • Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

Enlarged peripheral nerves are one of the cardinal manifestations of leprosy and the involvement of the great auricular nerve is well known. Enlargement of the “transverse cervical nerve” (also known as “superficial cervical” or “transverse cutaneous nerve of neck”) in leprosy is rarely reported.1 As depicted in Figures 1 and 2, we observed enlargement of bilateral transverse cervical nerves along with enlarged great auricular nerves in two patients with leprosy. The enlarged transverse cervical nerves were firm, cord-like, and tender on palpation. Their independent emergence, separate from the great auricular nerve, from the posterior border of sternocleidomastoid and an anteriorly directed course serves as an important guide in detecting them. Sural nerve biopsy revealed presence of lepra bacilli in both the cases (Figure 3).

Figure 1.
Figure 1.

Arrow: Great auricular nerve. Arrow-head: Transverse cervical nerve. L: Left side and R: Right side.

Citation: The American Society of Tropical Medicine and Hygiene 86, 3; 10.4269/ajtmh.2012.11-0602

Figure 2.
Figure 2.

Arrow: Great auricular nerve. Arrow-head: Transverse cervical nerve. L: Left side and R: Right side.

Citation: The American Society of Tropical Medicine and Hygiene 86, 3; 10.4269/ajtmh.2012.11-0602

Figure 3.
Figure 3.

Photomicrograph of sural nerve biopsy showing acid fast bacilli singularly (arrow heads) and in bundles (arrows) (Modified Ziehl-Neelsen stain, 1,000×).

Citation: The American Society of Tropical Medicine and Hygiene 86, 3; 10.4269/ajtmh.2012.11-0602

Similar to the great auricular nerve, transverse cutaneous nerve arises from second and third cervical nerves, turns around the posterior border of sternocleidomastoid muscle about its middle, courses obliquely forward, and supplies the antero-lateral part of the neck.2 We report bilaterally thickened transverse cervical nerves as a rare feature of leprosy. It can be added to the list of nerves enlarged in leprosy and may help in diagnosis.

  • 1.

    MacLeod JM, 1911. Case of Maculo-anesthetic Leprosy. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2004861/pdf/procrsmed00985-0016a.pdf. Accessed September 25, 2011.

    • Search Google Scholar
    • Export Citation
  • 2.

    Standring S, 2008. Head and neck. Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, Johnson D, Mahadevan V, Newell RL, Wigley C, eds. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. Fortieth edition. London, UK: Churchill Livingstone, 435466.

    • Search Google Scholar
    • Export Citation

Author Notes

*Address correspondence to Hardeep S. Malhotra, Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India. E-mail: drhsmalhotra@gmail.com

Authors’ addresses: Hardeep S. Malhotra and Ravindra K. Garg, Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India, E-mails: drhsmalhotra@gmail.com and garg50@yahoo.com. Madhu M. Goel, Department of Pathology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India, E-mail: madhukgmc@rediffmail.com.

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