A Review on Peripheral Nerve Injury
Abstract
Peripheral nerve injury(PNI) may result in a injury with a gap in the nerve or without gap. It is a largescale problem and is known to affect 2.8% of trauma patients. Unlike CNS, spontaneous regeneration may occur if the injury is small. Although for a deeper injury the regeneration might be partial or may not occur at all. These types of injuries are treated by surgeries using autografts or artificial nerve guidance conduits. Despite, major advancements in the treatment methods, the efficiency of the repair and functional recovery is still unpredictable. The purpose of this review is to present an overview of the Peripheral nerve injury, its pathology, types, and the various methods that are employed
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An injury on the nerves causes miscommunication between the organ and the brain which may cause pain or may lead to loss of sensation. Neuroregenaration refers to the repair or regrowth of the nerves which involves formation of new neurons, axons, myelin, glia or synapses. An injury in the PNS, if small, has a whole mechanism to heal and regenerate while healing mechanisms in the CNS is different. Regeneration the in the CNS is restricted by the inhibitory signals from the glia and the extracellular environment and forms scars rapidly. Not much is known about the mechanisms of the CNS. This review focuses on the Peripheral Nerve Injury and its treatment.
Over one million people are affected by PNI every year. Unlike the CNS, regeneration is probable in the PNS. Spontaneous regeneration may occur over relatively small injury. For larger damage, surgical repair is needed. (1) Number of microsurgical repair methods is available, depending upon the depth of the injury; they are treated by direct repair or autograft or allograft transplantation
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These changes at the site of injury begin almost immediately after the injury. The axons sprout multiple regenerating axons within few hours. Schwann cells are known to play an important role in guiding the regeneration of the axons by serving as a physical conduit. The distal segment of the injury undergoes a slow degeneration known as the Wallerian degeneration, after Augustus
VolneyWaller, who first characterized morphological changes in sectioned frog glossopharyngeal and hypoglossal nerves 160 years ago. (9) This involves breakdown of myelin and proliferation of
Schwann cells and invasion of macrophages at the distal end which clears the myelin and axonal debris. Changes in the levels of neurotrophins are also seen at both proximal and distal ends of the injury. It involves increased levels of Nerve Growth Factor (NGF), Brain-derived neurotropic factor (BDGF) is known to be secreted by Schwann cells. The surfaces of the Schwann cells and the surrounding extracellular matrix have increased Laminin, tenacin, neuronal cell adhesion molecules.
The muscles and the sensory organs also show changes such as shrinkage of cells, thickening
The central nervous system (CNS) comprises grey matter, which contains neuron cell bodies and white matter, which contains the nerve axons. Most of the nerve axons are concentrically wrapped around by lipid-rich biological membrane, known as the myelin sheath. In the CNS, myelin is produced by oligodendrocyte. a type of glial cell. (Pfeiffer et al., 1993). These electrical insulating, multilamellar membranes significantly increase the electrical resistance, in which to prevent leakage of electrical currents from the axons, as well as decrease electrical capacitance to reduce the ability of the axons to store electrical energy (Shivane &
The axons are slender processes of uniform diameter arising from the hillock. There is usually only one unbranched axon per neuron.
activities of the skin, muscles and many peripheral tissues. This includes the 12 cranial nerves
Unlike most other cells, neurons cannot regrow after damage (except neurons from the hippocampus). Fortunately, there are about 100 billion neurons in the brain.
Your friend’s dog, Spot, jumped onto a table with a terrarium housing your pet salamander, Lizzie. Unfortunately, the table tipped over and Spot has suffered a head injury which damaged the primary motor cortex. Lizzie lost most of the distal right forelimb in the accident. Please answer the following questions regarding the nervous system and regeneration, in a .docx, .pptx, or .pdf format.
Patient's complaints regarding weakness or lack of sensation often are rationalized as generalized sequel of the burn injury and healing process. However, these symptoms may be due to peripheral neuropathies and entrapment syndromes resulting from impaired nerve axons, or myelin sheath or both (7). Mononeuropathies and entrapment syndromes have been observed following thermal injury and most often affect nerves under the area of the burn, and they are usually seen in patient with burn greater than 20% of total body surface area (TBSA) (8).
Schwann cells are specialized cells found in the Peripheral Nervous System; they are dedicated to forming myelin sheaths around certain nerve fibers. These myelin sheaths aid in the conduction of nerve impulses and help to protect and electrically insulate these fibers. “Schwannomatosis is a rare
Peripheral nerve complications are generally directly attributed to the performance of the block itself, but this concept was challenged by Selander et al 1979, who indicated that other factors may be responsible as well. (Selander et al, 1979).
The focal lesion created by condition #2 alongside the larger size of the guinea pig (brainstem?) would facilitate the assessment of tonotopicity for any stem cell based treatment for SGN or HC replacement.
CRPS can be isolated into two sorts in light of the nonattendance (sort 1, a great deal more normal) or vicinity (sort 2) of an injury to a noteworthy nerve. ______ Lynne Turner-Stroke and Andreas Goebel.
Treating peripheral nerve injury is a major clinical challenge owing to the limited ability of the peripheral nerves to regenerate itself. Conventional treatment methods such as coaptation, autografting and xenografting possess inherent drawbacks such as reduced nerve stretching capacity, neuroma formation etc. To overcome these limitations, artificial nerve grafts employing natural or synthetic biomaterials are being developed. Axonal guidance structures and luminal fillers such as Schwann cells, stem cells, or nerve growth factors are also incorporated in the grafts to enhance their functionality. This paper reviews some of the biomaterials used in peripheral nerve regeneration, various modifications incorporated in them and their efficiency
Suprascapular nerve injury most commonly occurs in the confined space of the
The above process to neuronal regeneration takes place both in the peripheral and central nervous system however, a number of factors are present in the CNS for example Spinal cord injury causes a rapid stop of regeneration of damaged axons. The site of a spinal cord injury as a result of the phenomena occur eventually to produce a cavity filled with liquid syringomyelic CSF and covered with a layer of glial scar. This scar and cavity form a loss of continuity of long nerve pathways of the spinal cord and prevent the occurrence of neuronal regeneration process. Work on cellular therapies allowed researchers to isolate and implement of clinical transplantation experiments olfactory ensheathing glia (OGC). This is a population of cells with unique properties to stimulate the regeneration of CNS axons - opening the locking the glial scar, screening of regenerating axons and produce around casing. OGC activity may however be very limited in the case of spinal cord tissue defects dividing the axon ends. To solve the problem of syringomyelic cavity and loss of continuity of spinal cord tissue caused further studies of biomaterials. The aim is to create an artificial extracellular matrix that is likely to constitute a bridge for regenerating spinal cord fibers. Such an implant would stimulate neuronal regeneration process by establishing a physical connection between the ends of the spinal cord and could increase the efficiency of the use of OGC.
Due to injury to spinal cord the neurons and nerve fibres gets affected due to which patients may have any or all of these following complaints
BDNF is a neurotrophic factor that has demonstrated neural regeneration, reconnection, and improved synaptic efficacy.23