Clinical Features, Risk Factors, and Early Prognosis for Wallerian Degeneration in the Descending Pyramidal Tract after Acute Cerebral Infarction

Useless, NOTHING ON HOW TO PREVENT THIS.

Clinical Features, Risk Factors, and Early Prognosis for Wallerian Degeneration in the Descending Pyramidal Tract after Acute Cerebral Infarction

• Xiaolu Zheng, MD
• Yang Zhang, PhD
• Yi Man, MD
• Zhangyong Hu, MD
• Nan Zhang, MD
• Sipei Pan, PhD

Published:November 27, 2020DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105480

Abstract

Background

Wallerian degeneration(WD) occurs in the descending pyramidal tract(DPT) after cerebral infarction commonly, but studies of its degree evaluation, influencing factors and effects on nervous function are still limited.

Objectives

The purpose of this study was to describe these findings and estimate their clinical significance.

Methods

In total, 133 patients confirmed acute cerebral infarction and restricted diffusion in the DPT of the cerebral peduncle by MRI scans. These cases were retrospectively reviewed. We describe their clinical characteristics and analyze influence factors of WD, including the timespan from symptom onset to MRI and TOAST classification. Their NIHSS scores at admission and first 7 days NIHSS improvement rate after admission were also analyzed.

Results

These patients were divided into three groups by timespan ≤7 days( n = 45),7–14 days( n = 70) and >14 days( n = 18). The mean WD degree (%)of these three groups was 44.41 ± 22.51,52.35 ± 22.61and 44.31 ± 19.35,respectively( p = 0.122).According to the TOAST classification, the mean WD degree(%) of the cardioembolism group( n = 28, 62.80 ± 25.12) was significantly different from both the large-artery atherosclerosis group( n = 73,45.08 ± 20.03, p = 0.000) and the small-vessel occlusion group( n = 23,39.68 ± 16.95, p = 0.000). The mean NIHSS score upon admission of the WD degree≤50% group( n = 82,8.17 ± 5.87) was different from that of the >50% group( n = 51,11.31 ± 7.00)( p = 0.006). However, the mean 7 days NIHSS improvement rate(%) of the WD degree≤50% group( n = 79,11.83 ± 23.76)and >50% group( n = 50,13.40 ± 27.88) was not significantly different( p = 0.733).

Conclusions

Early WD in ischemic stroke patients has a correlation with serious baseline functional defects. Therefore, we should give close attention to imaging change, especially in those with cardioembolism .

 

The Cytokine Network of Wallerian Degeneration: Tumor Necrosis Factor-α, Interleukin-1α, and Interleukin-1β

This is the best I can do Elizabeth, your doctor should know whom to ask to explain it.
http://www.jneurosci.org/content/22/8/3052.short
Full 9 pages at the link.

Abstract

Wallerian degeneration (WD) is the inflammatory response of the nervous system to axonal injury, primarily attributable to the production of cytokines, the mediator molecules of inflammation. We presently document the involvement of the inflammatory cytokines TNFα, interleukin (IL)-1α, and IL-1β in peripheral nerve (PNS) injury in C57/BL/6NHSD (C57/BL) mice that display the normal rapid progression of WD (rapid-WD) and C57/BL/6-WLD/OLA/NHSD mice that display abnormal slow progression of WD (slow-WD). TNFα and IL-1α mRNAs were expressed, whereas TNFα but not IL-1α protein was synthesized in intact PNS of C57/BL mice. TNFα and IL-1α protein synthesis and secretion were rapidly upregulated during rapid-WD in Schwann cells. IL-1β mRNA expression and protein synthesis and secretion were induced sequentially in Schwann cells with a delay after injury. Thereafter, recruited macrophages contributed to the production of TNFα, IL-1α, and IL-1β, which in turn augmented myelin phagocytosis by macrophages. Observations suggest that TNFα and IL-1α are the first cytokines with protein production that is upregulated during rapid-WD. TNFα and IL-1α may initiate, therefore, molecular and cellular events in rapid-WD (e.g., the production of additional cytokines and NGF). TNFα, IL-1α, and IL-1β may further regulate, indirectly, macrophage recruitment, myelin removal, regeneration, and neuropathic pain. In contrast to rapid-WD, the production of TNFα, IL-1α, and IL-1β protein was deficient in slow-WD, although their mRNAs were expressed. mRNA expression and protein production of TNFα, IL-1α, and IL-1β were differentially regulated during rapid-WD and slow-WD, suggesting that mRNA expression, by itself, is no indication of the functional involvement of cytokines in WD.