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Wallerian degeneration is nerve fiber damage caused by injury or disease. The process begins with atrophy and separation of fibers, followed by regrowth attempts. Clinicians must understand the process to avoid further injury, and surgery can be used to guide nerve fibers.
Wallerian degeneration is a pattern of damage in nerve fibers in which the axon of a nerve breaks due to an injury that damages the core. When lesions appear along nerves, the opposite or distal ends can experience Wallerian degeneration. Nerve cells will try to grow and regenerate unless a scar or similar obstacle prevents them from doing so. In the peripheral nervous system, regrowth tends to be more rapid than in the central nervous system.
The process begins with an injury to a nerve such as a cut or crush or degeneration caused by a neurological disease. Within about a day, the fibers at the other end of the nerve begin to atrophy and separate because they are not getting enough nutrition. If the nerve supplies a muscle, it can become weak and small. This can happen on a small or large scale and can result in numbness, tingling and other unusual sensations for the patient.
After Wallerian degeneration, small shoots appear and try to reach the space left behind after the nerve fibers have broken down. If they are successful, they will leap across, restoring sensation and function to the area. The new nerves may not work as well, and the muscle may experience persistent weakness. When there are scars or other obstructions, the growing structures may not be able to pass through, leaving a void in place. The muscle will continue to atrophy because it is not getting enough signals from the nerves.
It is important for clinicians to understand the process of Wallerian degeneration. The extent of nerve damage can take several days to become apparent as the nerves break down, and patients can experience symptoms for months or years because the nerves don’t grow back properly or at all. When working around nerves, surgeons are careful to avoid creating injury and take note of any erosion of the myelin sheath or other problems that could contribute to Wallerian degeneration.
Surgery can be used to guide new nerve fibers if they have difficulty growing back successfully. This procedure requires a neurologist with considerable experience and training and can be a very delicate operation. When working with nerves, surgeons want to avoid making a problem worse than the one the patient started with. In some cases, regeneration cannot be encouraged and the patient will experience a permanent loss of sensation and function.
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