Cases reported "Wallerian Degeneration"

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11/18. Histological features of nerve fibers and endoneural vessels in a case of Wegener's granulomatosis.

    A sural nerve biopsy obtained from a patient with Wegener's granulomatosis and overt clinical signs of polyneuropathy showed degenerative changes of both myelinated and unmyelinated fibers. The pathological aspects were those of an axonopathy. Endoneural vessels were also involved, showing changes either in the endothelial cells, which were thickened and enriched with organelles, or in the basal membrane, which was reduplicated and thicker than in the controls. There were no cellular infiltrates nor was there clear evidence of fibrosis in the vascular wall. We suggest that peripheral neuropathy in Wegener's granulomatosis could be secondary to endoneural vessel changes on the basis of a possible immune complex action.
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ranking = 1
keywords = neuropathy
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12/18. Dysautonomia in guillain-barre syndrome with dorsal root ganglioneuropathy, wallerian degeneration, and fatal myocarditis.

    An acute guillain-barre syndrome presenting as dysautonomia is described in a 12-year-old boy. The patient died of intractable cardiac arrhythmias and cardiac failure. A severe myocarditis with destruction of dorsal root ganglion cells and wallerian degeneration of dorsal roots and peripheral nerves was apparent postmortem. Segmental demyelination and inflammatory cellular infiltrations were not present at these sites.
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ranking = 2
keywords = neuropathy
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13/18. Peripheral neuropathy associated with immunoglobulin disorders an immunological and ultrastructural study.

    light-, electron microscopic and immunopathological findings in a nerve biopsy of a patient with peripheral neuropathy associated with monoclonal gammopathy are reported. Loss of fibers, Wallerian-like degeneration and segmental demyelination were the most important features observed in light microscopy. In E.M. widening of the peripheral lamellae of myelin sheaths and occasional aspects of hypermyelination were seen. Immunoperoxidase study showed binding of IgM (k light chain) on the myelin sheath. The possible pathogenetic implications of these findings are discussed.
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ranking = 2.5
keywords = neuropathy
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14/18. A case of necrotic myelopathy due to a spinal vascular malformation (Foix-Alajouanine's disease).

    A woman of 65 years, after a period of painful paraesthesiae in the legs, developed a polyneuritic syndrome and also sphincter disturbance. At first the c.s.f. showed albuminocytological dissociation. The polyneuropathy was initially thought to be of diabetic origin, as the blood sugar was moderately raised. For nearly two years the symptoms were not very disabling, in spite of variations in severity, but then there was a sudden onset of severe paraplegia with a sensory level of D 6--7 and bilateral extensor responses. myelography was abnormal but inconclusive. Her clinical condition gradually deteriorated and severe pressure sores developed. death occurred five years after the appearance of the first symptoms. Post-mortem examination revealed diffuse necrosis in most of the thoracic region of the cord which showed at this level a large arterio-venous angioma on its posterior part.
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ranking = 0.5
keywords = neuropathy
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15/18. guillain-barre syndrome in northern china. The spectrum of neuropathological changes in clinically defined cases.

    The pathology of the guillain-barre syndrome remains controversial, and autopsied cases available for study by contemporary techniques are uncommon. Large numbers of cases clinically diagnosed as guillain-barre syndrome occur in northern china. In this study we examined the neuropathological changes in 12 autopsied cases from Hebei Province, china. Eleven died early in the course of their disease. In all cases tissue was specially handled and fixed for electron microscopy and for immunocytochemistry. Three of these 12 cases had typical acute inflammatory demyelinating polyneuropathy (AIDP) with lymphocytic infiltration and macrophage-mediated demyelination, reproducing the pathological picture most often reported in guillain-barre syndrome in north america, europe, and australia. Six cases had predominantly axonal involvement, characterized by Wallerian-like degeneration of nerve fibres, with only minimal demyelination and with minimal inflammation in five. Three cases, even though paralysed at the time of death, had only very mild changes in the spinal roots and sciatic nerves. Within the group of six predominantly axonal cases, there were important differences both in the severity of the abnormalities and in the classes of fibres involved. Three cases had extensive Wallerian-like degeneration of sensory as well as motor fibres [acute motor-sensory axonal neuropathy (AMSAN)], while in the other three cases the fibre degeneration affected the motor nerve fibres almost exclusively. These latter cases establish a structural basis for the clinical and electrophysiological picture termed the acute motor axonal neuropathy (AMAN) pattern. In both the AMAN and the AMSAN patterns, a prominent feature was the presence of macrophages within the periaxonal space, surrounding or displacing the axon, and surrounded by an intact myelin sheath. These studies show that the early pathological changes in cases clinically diagnosed as the guillain-barre syndrome are diverse and not restricted to the well-known pattern of AIDP, and that the predominant pathological patterns may differ in different parts of the world. The differences in pathological findings between acute inflammatory demyelinating polyneuropathy and the axonal patterns are likely to reflect differences in the pathogenetic mechanisms. The periaxonal macrophages in the axonal patterns suggest that an important epitope may be localized to the axolemma or periaxonal space. The mild cases indicate that severe paralysis can occur early in guillain-barre syndrome without prominent structural changes along the nerve, suggesting that physiological block or nerve terminal changes may be implicated.
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ranking = 52.221648436402
keywords = axonal neuropathy, neuropathy
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16/18. Severe axonal polyneuropathy with onset in the postpartum period.

    We report two patients who presented severe polyneuropathy in the postpartum period. Electrophysiological studies evidenced an axonal process which was associated with proximal demyelination in the second patient. In both cases, a peripheral nerve biopsy showed severe axonal Wallerian-like degeneration and no feature of demyelination. The first patient had a dramatic loss of myelinated fibres, and severe disability persisted for several months. These two patients are different from cases of acute or chronic inflammatory demyelinating polyradiculoneuropathy previously reported in relation with pregnancy.
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ranking = 3
keywords = neuropathy
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17/18. Sensory and motor neuropathy caused by excessive ingestion of vitamin B6: a case report.

    We describe a patient who developed a severe sensory and a mild motor neuropathy. This syndrome was due to massive and prolonged ingestion of vitamin B6 (10 g daily for 5 years). To our knowledge this is the first published case of motor neuropathy caused by chronic abuse of vitamin B6.
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ranking = 3
keywords = neuropathy
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18/18. Motor nerve terminal degeneration provides a potential mechanism for rapid recovery in acute motor axonal neuropathy after Campylobacter infection.

    We investigated the possible mechanisms of paralysis and recovery in a patient with the acute motor axonal neuropathy (AMAN) pattern of the guillain-barre syndrome. The AMAN pattern of GBS is characterized clinically by acute paralysis without sensory involvement and electrodiagnostically by low compound motor action potential amplitudes, suggesting axonal damage, without evidence of demyelination. Many AMAN patients have serologic or culture evidence of recent campylobacter jejuni infection. Pathologically, the most severe cases are characterized by wallerian-like degeneration of motor axons affecting the ventral roots as well as peripheral nerves, but some fatal cases have only minor changes in the roots and peripheral nerves, and some paralyzed patients with the characteristic electrodiagnostic findings of AMAN recover rapidly. The mechanism of paralysis and recovery in such cases has been uncertain. A 64-year-old woman with culture-proven campylobacter upsaliensis diarrhea developed typical features of AMAN. She improved quickly following plasmapheresis. Her serum contained IgG anti-GM1 antibodies. The lipopolysaccharide of the organism bound peanut agglutinin. This binding was blocked by cholera toxin, suggesting that the organism contained the Gal(beta1-3)GalNAc epitope of GM1 in its lipopolysaccharide. Motor-point biopsy showed denervated neuromuscular junctions and reduced fiber numbers in intramuscular nerves. In contrast, the sural nerve biopsy was normal and skin biopsy showed normal dermal and epidermal innervation. In AMAN the paralysis may reflect degeneration of motor nerve terminals and intramuscular axons. In addition, the anti-GM1 antibodies, which can bind at nodes of Ranvier, might produce failure of conduction. These processes are potentially reversible and likely to underlie the capacity for rapid recovery that characterizes some cases of AMAN.
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ranking = 128.054121091
keywords = axonal neuropathy, neuropathy
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