A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Science
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Medicine -- Practice
(_c_) Under the head of degenerative atrophies should be included the
secondary changes which affect certain nerve-tracts within the nervous
system itself. It is impossible in this introduction to treat fully of
this interesting category of trophic changes; the following summary
must suffice: (1) When the cerebral motor cortex or any part of the
associated pyramidal (or motor) tract is destructively injured, there
occurs, in from three to six weeks, a degeneration of the whole tract
caudad of (below) the brain. The myeline becomes granular and
disappears, the cylinder-axes are broken up and vanish, the connective
tissue (neuroglia) increases in amount; the atrophied and degenerated
area appears in a transection rather translucent in contrast to the
pearly white of the normal medullary tissue, and when the preparation
is stained with carmine the patch takes up an abnormal amount of
pigment. This is the so-called descending degeneration, or centrifugal
atrophy of the central nervous system. (2) After total transverse
lesions of the spinal cord, besides the above-described centrifugal
degeneration caudad of the lesion, we observe frontad of (above) it
similar changes in the posterior median columns, and in the direct
cerebellar tracts—centripetal degeneration. At present we have no
knowledge of centripetal (ascending) degenerations in the cerebrum and
in nerve-trunks; and if the results of von Gudden's experimental
method be cited against this statement, it must be replied that its
effects are best seen in newly-born animals, and that its pathology is
yet unknown. (3) Lesions of the anterior gray matter (ventral cornua)
of the spinal cord, and of mixed nerve-trunks produce only centrifugal
or descending degeneration. All the nerve-fibres deriving their
innervation from the injured area in the cord, or in case of nerves
all fibres below the injury, perish—_i.e._ their myeline breaks up and
undergoes granular and fatty degeneration, their cylinder-axes are
segmented and disappear, while at the same time the connective tissue
of the nerve becomes abnormally active and increases. Furthermore, in
cases of this category there are, inevitably, degenerative and
atrophic changes in the attached muscles, and peculiar
electro-muscular reactions (vide supra). All these central and
peripheral nervous degenerations, due to a local lesion, are
conveniently grouped under the name of Wallerian degeneration.
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