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Wallerian Degeneration of the Superior Cerebellar Peduncle

Thomas Decramer, MD1; Philippe Demaerel, MD, PhD2; Johannes van Loon, MD, PhD1; Vincent Thijs, MD, PhD3,4,5
[+] Author Affiliations
1Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
2Department of Radiology, University Hospitals Leuven, Leuven, Belgium
3KU Leuven–University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium
4VIB–Vesalius Research Center, Leuven, Belgium
5Department of Neurology, University Hospitals Leuven, Leuven, Belgium
JAMA Neurol. 2015;72(10):1206-1208. doi:10.1001/jamaneurol.2015.1170.
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Extract

This case report describes a man who presented with a deep cerebellar hemorrhage with damage to the dentate and interposite nuclei.

Wallerian degeneration (WD) occurs after nerve damage in both the peripheral nervous system and central nervous system (CNS). Wallerian degeneration is named after Augustus Volney Waller (1816-1870), a British neurophysiologist who observed distal nerve changes after experimental lesions of the hypoglossal nerve in frogs.1 The distal part of the axon of the damaged nerve degenerates, a process called orthograde degradation. Histologically, WD is characterized by structural loss of the cytoskeleton, a process that takes roughly 24 hours in the peripheral nervous system and days to weeks in the central nervous system.

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Figure 1.
Computed Tomographic Images on Admission and Magnetic Resonance Images After Hemorrhage

A, Computed tomography showing the cerebellar bleed as a hyperdense lesion (arrowhead). B, T1-weighted imaging shows the cerebellar bleed as a spontaneous hyperintense lesion (arrowhead). C, Diffusion-weighted imaging shows high signal intensity in the ipsilateral superior cerebellar peduncle (arrowhead), compatible with early Wallerian degeneration. D, There is atrophy and increased signal intensity in the right superior cerebral peduncle (arrowhead). E, The contralateral red nucleus appears smaller (arrowhead). F, In the medulla, there is hypertrophy and hyperintensity of the contralateral olivary nucleus (arrowhead). These findings are compatible with late Wallerian degeneration.

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Figure 2.
Anatomical Circuit

Information of the cerebellar cortex is sent to the dentate nucleus. From there on, nerve fibers travel to the contralateral red nucleus, which carries this information to the thalamus and cortex. This is called the dentate-rubral-thalamic-(cortical) tract, which proximally runs through the superior cerebellar peduncle. However, there is also a feedback loop inside the brainstem: the red nucleus is connected with the inferior olivary nucleus through the central tegmental tract. From the inferior olivary nucleus, climbing fibers cross the midline and travel through the inferior cerebellar peduncle to the contralateral cerebellar hemisphere. This feedback loop is also known as the triangle of Guillain-Mollaret.

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