Sprouting of primary afferent fibers after spinal cord transection in the rat

After spinal cord injury, hyper-reflexia can lead to episodic hypertension, muscle spasticity and urinary bladder dyssynergia. This condition may be caused by primary afferent fiber sprouting providing new input to partially denervated spinal interneurons, autonomic neurons and motor neurons. However, conflicting reports concerning afferent neurite sprouting after cord injury do not provide adequate information to associate sprouting with hyper-reflexia. Therefore, we studied the effect of mid-thoracic spinal cord transection on central projections of sensory neurons, quantified by area measurements. The area of myelinated afferent arbors, immunolabeled by cholera toxin B, was greater in laminae I-V in lumbar, but not thoracic cord, by one week after cord transection. Changes in small sensory neurons and their unmyelinated fibers, immunolabeled for calcitonin gene-related peptide, were assessed in the cord and in dorsal root ganglia. The area of calcitonin gene-related peptide-immunoreactive fibers in laminae III-V increased in all cord segments at two weeks after cord transection, but not at one week. Numbers of sensory neurons immunoreactive for calcitonin gene-related peptide were unchanged, suggesting that the increased area of immunoreactivity reflected sprouting rather than peptide up-regulation. Immunoreactive fibers in the lateral horn increased only above the lesion and in lumbar segments at two weeks after cord transection. They were not continuous with dorsal horn fibers, suggesting that they were not primary afferent fibers. Using the fluorescent tracer DiI to label afferent fibers, an increase in area could be seen in Clarke's nucleus caudal to the injury two weeks after transection. In conclusion, site- and time-dependent sprouting of myelinated and unmyelinated primary afferent fibers, and possibly interneurons, occurred after spinal cord transection. Afferent fiber sprouting did not reach autonomic or motor neurons directly, but may cause hyper-reflexia by increasing inputs to interneurons.     

Histologic analysis of the lumbosacral nerve roots after compression in young and aged rabbits

STUDY DESIGN: The histologic changes in the lumbosacral nerve roots of aged rabbits because of chronic (graded) and acute compression were compared with those seen in young rabbits. OBJECTIVES: To study differences in the process of recovery from nerve compression between the aged and the young. SUMMARY OF BACKGROUND DATA: Clinical findings often differ between nerve compressive lesions in young and aged patients. Little has been reported on the pathologic basis of this difference. METHODS: Forty-five Japanese white rabbits were used. The cauda equina and spinal nerve root were compressed with a device specifically designed for this purpose. Nerve compression was applied to the dura mater and nerve roots after partial laminectomy. The specimens were sampled at 1 month or 3 months after acute or graded nerve compression. RESULTS: An increase in small myelinated fibers, consistent with the process of regeneration, was observed by light microscopy; this difference was greater in the young group than in the aged group. Reactive degenerative changes, as seen by electron microscopy, were more often observed in the aged group than in the young group. CONCLUSIONS: These findings demonstrate the suppression of regeneration and the latent fragility of the aged neural tissue. This may explain the clinical findings observed in aged patients with degenerative lumbar lesions.     

Intradermal injection of capsaicin in humans produces degeneration and subsequent reinnervation of epidermal nerve fibers: correlation with sensory function

The ability of capsaicin to excite and subsequently to desensitize a select group of small sensory neurons has made it a useful tool to study their function. For this reason, application of capsaicin to the skin has been used for a variety of painful syndromes. We examined whether intradermal injection of capsaicin produced morphological changes in cutaneous nerve fibers that would account for its analgesic properties by comparing cutaneous innervation in capsaicin-treated skin with psychophysical measures of sensation. At various times after capsaicin injection, nerve fibers were visualized immunohistochemically in skin biopsies and were quantified. In normal skin the epidermis is heavily innervated by nerve fibers immunoreactive for protein gene product (PGP) 9.5, whereas fibers immunoreactive for substance P (SP) and calcitonin gene-related peptide (CGRP) are typically associated with blood vessels. There was nearly complete degeneration of epidermal nerve fibers and the subepidermal neural plexus in capsaicin-treated skin, as indicated by the loss of immunoreactivity for PGP 9.5 and CGRP. The effect of capsaicin on dermal nerve fibers immunoreactive for SP was less obvious. Capsaicin decreased sensitivity to pain produced by sharp mechanical stimuli and nearly eliminated heat-evoked pain within the injected area. Limited reinnervation of the epidermis and partial return of sensation occurred 3 weeks after treatment; reinnervation of the epidermis was approximately 25% of normal, and sensation improved to 50-75% of normal. These data show that sensory dysfunction after capsaicin application to the skin results from rapid degeneration of intracutaneous nerve fibers.     

Receptive properties of mouse sensory neurons innervating hairy skin

Using an in vitro nerve skin preparation and controlled mechanical or thermal stimuli, we analyzed the receptive properties of 277 mechanosensitive single primary afferents with myelinated (n = 251) or unmyelinated (n = 26) axons innervating the hairy skin in adult or 2-wk-old mice. Afferents were recorded from small filaments of either sural or saphenous nerves in an outbred mice strain or in the inbred Balb/c strain. On the basis of their receptive properties and conduction velocity, several receptor types could be distinguished. In adult animals (>6 wk old), 54% of the large myelinated fibers (Abeta, n = 83) showed rapidly adapting (RA) discharges to constant force stimuli and probably innervated hair follicles, whereas 46% displayed a slowly adapting (SA) response and probably innervated Merkel cells in touch domes. Among thin myelinated fibers (Adelta, n = 91), 34% were sensitive D hair receptors and 66% were high-threshold mechanoreceptors (AM fibers). Unmyelinated fibers had high mechanical thresholds and nociceptive functions. All receptor types had characteristic stimulus-response functions to suprathreshold force stimuli. Noxious heat stimuli (15-s ramp from 32 to 47 degrees C measured at the corium side of the skin) excited 26% (5 of 19) of AM fibers with a threshold of 42.5 +/- 1.4 degrees C (mean +/- SE) and an average discharge of 15.8 +/- 9.7 action potentials and 41% (7 of 17) C fibers with a mean threshold of 37.6 +/- 1.9 degrees C and an average discharge of 22.0 +/- 6.0 action potentials. Noxious cold stimuli activated 1 of 10 AM fibers and 3 of 10 C fibers. One of 10 C units responded to both heat and cold stimuli. All types of afferent fibers present in adult mice could readily be recognized in mice at postnatal day 14. However, fibers had reduced conduction velocities and the stimulus-response function to mechanical stimuli was more shallow in all fibers except for the D hairs. In juvenile mice, 22% of RA units also displayed an SA response at high stimulus intensities; these units were termed RA/SA units. We conclude that all types of cutaneous afferent fibers are already committed to their phenotype 2 wk after birth but undergo some maturation over the following weeks. This preparation has great potential for the study of transgenic mice with targeted mutations of genes that code factors that are involved in the specification of sensory neuron phenotypes.     

Trigeminal neuropathic pain: pathophysiological mechanisms examined by quantitative assessment of abnormal pain and sensory perception

OBJECTIVE: This study was undertaken to examine the pathophysiological characteristics of trigeminal neuropathic pain. METHODS: The study included 23 consecutive patients with trigeminal neuropathic pain (15 patients with pain after nerve injury and 8 patients with pain of spontaneous origin). For each patient, quantitative examination of sensory and pain perception was performed in the painful facial skin area, and results were compared with the findings for the contralateral nonpainful facial skin area. RESULTS: In the painful facial skin area of patients with neuropathic pain after nerve injury, we demonstrated increased temperature and tactile thresholds, as well as abnormal temporal summation of pain (i.e., repetitive nonpainful skin stimulation produced an abnormal progressive increase of pain intensity, with abnormal radiation of pain and aftersensation). In the painful skin area of patients with pain of spontaneous origin, temperature and tactile thresholds were not increased, but heat pain and cold pain thresholds were significantly reduced, indicating heat and cold hyperalgesia. The characteristics of temporal summation of pain were not significantly altered in the painful facial skin area in this group of patients. CONCLUSION: This clinical study provides evidence that the pathophysiological mechanisms of trigeminal neuropathic pain after nerve injury involve impaired function of both small unmyelinated fibers and large myelinated fibers. An explanation for the finding of abnormal temporal summation of pain may involve hyperexcitability of central wide-dynamic range neurons. The results suggest that other mechanisms are involved in trigeminal neuropathic pain of spontaneous origin. Reduced heat and cold pain thresholds indicate heat and cold hyperalgesia, which possibly may be explained by sensitization of peripheral C nociceptors.     

Characterization of mechanosensitive pelvic nerve afferent fibers innervating the colon of the rat

1. Single-unit activity was recorded from S1 sacral dorsal root afferent fibers in the anesthetized rat. A total of 364 afferent fibers were identified by electrical stimulation of the pelvic nerve and subsequently tested for response to colorectal distension (CRD) and urinary bladder distension (UBD). Sixty-seven percent (n = 244) of the fibers were unmyelinated C-fibers and 33% (n = 120) were thinly myelinated A delta-fibers. 2. In three initial experiments, 35 fibers were identified by pelvic nerve stimulation and tested for response only to CRD; none of these fibers responded to CRD. In 20 subsequent experiments, 329 pelvic nerve afferent fibers were tested for response to CRD and UBD. Thirty-four percent (n = 112) of the 329 fibers were unresponsive to noxious CRD (80 mmHg) or to UBD (slow filling < or = 100 mmHg), 44% (n = 146) responded to UBD, 16% (n = 53) responded to CRD, and 6% (n = 18) responded to mechanical stimulation of the anal mucosa. 3. Of the total of 53 pelvic nerve afferent fibers that responded to CRD, 43 (81%) were C-fibers (mean: 1.5 m/s) and 10 (19%) were A delta-fibers (mean: 4.7 m/s). Fifteen of the CRD-sensitive fibers had no resting activity, whereas 38 fibers exhibited some resting activity (mean: 2.6 imp/s). 4. Reproducibility of responses to repeated CRD (80 mmHg, 30s, 10 trials at 4-min intervals) was tested in 17 fibers. In 16, responses to repeated distension were reproducible without evidence of facilitation or inhibition of subsequent responses. One fiber gave greater responses during the 9th and 10th trials. 5. Responses to graded CRD were studied in 44 fibers. All fibers exhibited monotonic, increasing stimulus-response functions < or = 80 mmHg of distension. Thresholds for response of the 44 fibers were determined after extrapolation of the least-squares linear-regression line to the ordinate and varied between 0 and 40 mmHg. Two populations of pelvic nerve afferent fibers in the colon were apparent: low threshold (LT) afferent fibers had a mean threshold of 2.9 mmHg (range: 0-10 mmHg; n = 34) and high threshold (HT) afferent fibers had a mean threshold of 32.6 mmHg (range: 28.0-40.0 mmHg; n = 10). 6. Chemosensitivity to bradykinin (BK) was tested in nine LT fibers. Seven fibers responded to BK (0.1 to 100 micrograms/kg ia) and two fibers did not respond up to 100 micrograms/kg of BK. Responses to BK tested in three fibers were dose dependent.(ABSTRACT TRUNCATED AT 400 WORDS)     

Electrophysiologic analysis of the lumbosacral radiculopathy using nerve root conduction velocity (NRCV) and cauda equina action potentials (CEAP)

Nerve root conduction velocity (NRCV) and cauda equina action potential (CEAP) have been measured to assess the severity of lumbosacral radiculopathy, the level-specific diagnosis of the symptomatic roots, and to predict the outcome. This study included 71 patients (40 males, 31 females, average age of 54 years at the time of surgery) who underwent decompressive surgery for lumbar radiculopathy. The NRCV and CEAP were directly measured during the operation. The NRCV decreased significantly with progression of radicular symptoms. The NRCV showed a marked reduction in the nerve roots of the patients with a two years or longer history of radicular symptoms; or those with compression of the nerve roots on the imaging examinations; or nerve roots that were considered to have been subjected to persistent compression over a prolonged period with severe inflammation and adhesions. Multivariative analyses suggested that the NRCV correlated closely to the postoperative neurologic recovery, and the outcome of the lumbosacral radiculopathy could be predicted to some extent by measurements of NRCV. The level-specific diagnosis of the radiculopathy could be determined when the CEAP showed a more than 30% left-right potentials difference.     

The afferent code for sensory quality.

"Many of the more recent findings in sensory psychology and physiology derive from the application of electrophysiology to the study of sensory processes." Experiments involving the taste sense and utilizing the recording and amplifying of nerve impulse traffic in sensory fibers "en route" to the brain are reviewed, and their general implications for the theory of afferent coding are discussed. An important principle of sensory coding is that "the same afferent fiber may convey different information depending upon the amount of activity in another parallel fiber." The relative rather than the absolute amount of activity in any one set of afferent fibers may determine the quality of sensation. "It is not only the activity in parallel fibers that is important, it is the relative amount of such parallel activity. Studies of the other senses indicate that these principles are not unique to taste." 21 refs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of a soluble tetrazolium compound to assay metabolic activation of intact beta cells

The study was performed to evaluate differential neural blockade during lumbar epidural anesthesia with a cutaneous current perception threshold (CPT) sensory testing device. Fourteen patients undergoing elective gynecological surgery received 10 ml of 2% lidocaine through an epidural catheter inserted at the L 1/2 interspace. CPTs at 2000, 250, and 5 Hz stimulation and sensation to light touch, temperature, and pinprick at ipsilateral dermatomes V, Th 9, and L 2 were measured before and every 5 min, until 60 min after the epidural lidocaine. The epidural block caused a significant increase in all CPTs at dermatome L 2 and in CPTs at 250 and 5 Hz at Th 9. Touch sensation at Th 9 was intact during the study period in 12 patients, most of whom lost sensation to the other stimulus: 12 patients did not respond to the cold stimulus and 10 patients to the pinprick. At L 2, sensory block to light touch, temperature, and pinprick was found in 11, 14, and 14 patients, respectively. There was no effect on any measurements made at V. In conclusion, epidural lidocaine results in a differential neural blockade as measured with CPT testing. Since the 2000-Hz stimulus detect abnormalities that correlate with large fiber functioning, it is suggested that loss of touch sensation is associated with effects of epidural lidocaine on large fibers.     

Target discrimination in regenerating insect sensory nerve

The paired abdominal cerci of the cricket Acheta domesticus are mechanosensory appendages which regenerate readily when amputated during larval life. Their peripherally-located sense cells form axons which project centrally as a purely sensory nerve to the terminal abdominal ganglion. In an attempt to analyze some of the factors which guide a regenerating sensory nerve to correct central terminations, implants of homologous, supernumerary terminal ganglia were made in cricket larvae and the host cerci amputated. The possibility that implants with multiple nerve stumps might release an attracting substance was considered. Surgical procedures used were (1) implant in posterior abdomen; (2) implant in posterior abdomen, ipsilateral to chronic cercal deprivation; (3) implant in mesothoracic leg socket, adjacent to heterotopically-transplanted regenerated cercus; (4) implant in posterior abdomen, ipsilateral host cercal motor nerve sectioned; (5) implant in posterior abdomen, ipsilateral margin of host terminal ganglion wounded. Results were determined after the adult molt, by conventional histology or by cobalt chloride filling of regenerated cercal nerves. In all procedures except (3) and (4), the regenerated afferent nerve bypassed the implant and terminated in the host terminal ganglion. In (3), the regenerated fibers from cercal grafts bypassed the implant; terminations were not found. In (4), some regenerated cercal axons connected with the implant and the majority terminated in the host ganglion. It is suggested that regenerating cercal afferents may depend in a facultative way on the cercal motor nerve as a pathway guide but there is as yet no clear evidence for a trophic influence from the central nervous system.     

A quantitative study of nerve fibers in the human facial nerve

The facial and intermediate nerves were quantitatively evaluated in seven patients who died from systemic malignancies not involving the facial nerve. In addition, five of the specimens were also qualitatively evaluated by measuring the total and axon diameters of the facial and intermediate nerve fibers. In two cases the facial nerve fibers were counted at five different levels. The total number of myelinated nerve fibers in the facial nerve varied from 7500 to 9370. The total number of myelinated nerve fibers in the intermediate nerve varied between 3120 and 5360. The peak diameter of the facial nerve axon was between 4 and 6 microns, and was between 2 and 3 microns in the intermediate nerve. When comparing nerve segments at different anatomical levels, the largest amount of nerve fibers was found at the level of the middle mastoid portion. However, this number did not reach the amount of nerve fibers counted in the internal acoustic meatus.     

Sex differences in sensory and motor branches of the pudendal nerve of the rat

The morphology of the pudendal nerve was quantified in adult male and female rats. The sensory branch of the pudendal nerve was about three times as large in cross section in males as in females, and the motor branch was about five times as large. Electron microscopy was used to determine the ultrastructural bases of these gross size differences. Differences that were found included greater packing density of both myelinated and unmyelinated axons in females, larger myelinated and unmyelinated axons in males, larger myelin sheaths of sensory axons in males, more numerous myelinated axons in both branches of males, and more numerous unmyelinated axons in the sensory branch of males. There was also some indication that myelinated sensory axons were more likely to branch in the dorsal clitoral nerve of females than in the homologous nerve of males. Morphological differences in the structure of pudendal axons, their associated Schwann cells, and the extracellular matrix as well as differences in sensory and motor axonal number all have potential implications for the sexual differentiation of the central nervous system and behavior.     

Primary afferent depolarizations of sensory origin within contact-sensitive mechanoreceptive afferents of a crayfish leg

Recordings from the central branches of single identified dactyl sensory afferent (DSA) neurons in a crayfish in vitro preparation were performed to study modifications of the sensory message occurring before the first central synapse. These afferents comprised hairs and force-sensitive mechanoreceptors with phasic and phasotonic response characteristics in the terminal segment (dactyl) of the crayfish leg. More than one afferent spike size was often observed in intracellular recordings from these afferents, thus indicating the presence of electrical coupling between the central processes of DSA fibers. Additionally, in identified DSA fibers with large spike sizes, primary afferent depolarizations (PADs) of up to 15 mV were observed, which sometimes triggered antidromic spikes in the afferent. Nevertheless, PADs were clearly inhibitory, because they shunted the afferent spikes. They exhibited the following properties. First, each PAD was preceded by an afferent spike from a neighboring hair, indicating that the PADs had a sensory rather than central origin. Second, PADs could follow high frequencies of afferent discharges without failure, a property suggestive of monosynaptic connections, but because PAD latencies varied by +/-0.5 ms it is more likely that they were mediated by a disynaptic pathway. Third, although PADs were evoked in an extremely reliable manner, their amplitude varied in a quantal manner. Most unitary PADs were the result of the release of < 12 quanta, the mean quantal content lying between 4 and 5; quantal size was large, approximately 1 mV. Fourth, PADs showed facilitation in some fibers, whereas in others they became much smaller when occurring at brief intervals. We suggest that PADs may be an efficient and parsimonious way to limit sensory inflow in space and time, allowing the crayfish to identify precisely both weak and strong mechanical stimuli.     

ATP P2x receptors and sensory synaptic transmission between primary afferent fibers and spinal dorsal horn neurons in rats

ATP P2x receptors and sensory synaptic transmission between primary afferent fibers and spinal dorsal horn neurons in rats. J. Neurophysiol. 80: 3356-3360, 1998. Glutamate is a major fast transmitter between primary afferent fibers and dorsal horn neurons in the spinal cord. Recent evidence indicates that ATP acts as another fast transmitter at the rat cervical spinal cord and is proposed to serve as a transmitter for nociception and pain. Sensory synaptic transmission between dorsal root afferent fibers and neurons in the superficial dorsal horn of the lumbar spinal cord were examined by whole cell patch-clamp recording techniques. Experiments were designed to test if ATP could serve as a transmitter at the lumbar spinal cord. Monosynaptic excitatory postsynaptic currents (EPSCs) were completely abolished after the blockade of both glutamatergic alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainate and N-methyl--aspartate receptors. No residual current was detected, indicating that glutamate but not ATP is a fast transmitter at the dorsal horn of the lumbar spinal cord. Pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), a selective P2x receptor antagonist, produced an inhibitory modulatory effect on fast EPSCs and altered responses to paired-pulse stimulation, suggesting the involvement of a presynaptic mechanism. Intrathecal administration of PPADS did not produce any antinociceptive effect in two different types of behavioral nociceptive tests. The present results suggest that ATP P2x2 receptors modulate excitatory synaptic transmission in the superficial dorsal horn of the lumbar spinal cord by a presynaptic mechanism, and such a mechanism does not play an important role in behavioral responses to noxious heating. The involvement of other P2x subtype receptors, which is are less sensitive to PPADS, in acute nociceptive modulation and persistent pain remains to be investigated.     

Unmyelinated nerve fibers in senile nerves and in late thalidomide neuropathy: a quantitative electron microscopic study (author's transl)

Sural nerve biopsies of four patients, aged 54--76 years, with a predominantly sensory type of neuropathy following high dosages of thalidomide were examined by light and electron microscopy. The present study includes a qualitative and quantitative evaluation of unmyelinated nerve fibers. Despite severe neuropathy, increased numbers of small unmyelinated axons per endoneurial area were noted in all patients. This numerical increase appeared to be independent of aging, since it was not seen in two senile controls, studied at the age of 83 and 88 years. The increase in the endoneurial density of unmyelinated axons, especially of small sized fibers, is likely to be related to regeneration following degeneration of unmyelinated axons although endoneurial shrinkage secondary to loss of large myelinated fibers could have caused an additional increase in the number of axons per endoneurial area. Axonal sprouting, despite degeneration of large numbers of myelinated and unmyelinated fibers, appears to be consistent with some of the characteristic clinical features of thalidomide neuropathy such as paresthesias, hyperesthesia for pain and temperature, and disturbances of autonomic functions. On the other hand, a variable number of empty Schwann cells (bands of Büngner) and pockets at the surface of many Schwann cells noted in the four patients with neuropathy were also seen in both senile controls with no signs of neuropathy. Thus, it is obvious that pockets and empty Schwann cells may be related to aging or other causes of slow axonal wasting with Schwann cell proliferation and are not necessarily associated with clinically manifest neuropathy.     

Quantitative analysis of edema in the dorsal nerve roots induced by acute mechanical compression

STUDY DESIGN: Edema in the dorsal nerve roots caused by acute compression was assessed quantitatively in the lumbar spine of the adult dog. OBJECTIVE: To establish quantitative evaluation of edema in the dorsal nerve roots and to observe changes after acute compression with time. SUMMARY OF BACKGROUND DATA: Mechanical compression induces an increase in microvascular permeability of the endoneurial capillaries and results in intraneural edema. However, there are no quantitative studies on edema in the nerve roots. METHODS: The seventh lumbar nerve root was compressed with a 60-g force clip for 10 minutes. The nerve roots were removed immediately and at 24 hours, 1 week, and 3 weeks after compression. Nerve roots from the control and the sham groups were also obtained. Before removing the nerve roots, Evans blue albumin was injected intravenously. Changes in edema were examined using fluorescence microscopy. Evans blue albumin emits a bright red fluorescence. The relative red fluorescent area was calculated using computer image analysis, and the data were used to indicate the degree of edema. RESULTS: In the compressed segment, edema was most pronounced just after decompression and reduced in nerves removed at 24 hours. In nerves removed at 1 week, edema was pronounced but was reduced at 3 weeks. In the segments closest to the spinal cord, edema was seen after 1 week and was significant after 3 weeks. In the segments closest to the dorsal root ganglion, edema was not detected at any time. CONCLUSION: In the dorsal nerve roots the degree and the area of edema changed with time elapsed after acute compression. The degree of edema 24 hours after decompression was one third the degree immediately after decompression. These results show that edema induced by mechanical compression can recover after decompression.     

Quantitative assessment of differential sensory blockade after lumbar epidural lidocaine

A cutaneous current perception threshold (CPT) sensory testing device measures both large and small diameter sensory nerve fiber function and may be useful in evaluating differential neural blockade. Eight subjects received both lumbar epidural saline and lumbar epidural lidocaine. Five milliliters of normal saline was administered and the CPTs were measured. After the saline, 10 mL of 2% plain lidocaine was administered. CPTs, and sensation to touch, pinprick, and cold were subsequently measured. Saline had no effect on any measurements. Lidocaine caused an increase in all CPTs at the umbilicus and the knee reaching a statistical significance at 5 Hz for the umbilicus only. The great toe showed a slight increase of the 5 Hz stimulus and no increase of the 2000 or 250 Hz stimulus. There was a significant decrease in touch, pinprick, and cold sensation at the umbilicus and knee and a significant decrease in the cold sensation at the great toe. There was no effect on any measurements made at the mastoid. Epidural lidocaine resulted in a differential neural blockade as measured by a CPT monitor but not with crude sensory measurements.     

Motor fibers in the sural nerve of humans

Although motor fibers in the sural nerve were already described in three individuals, this nerve is considered purely sensory. We investigated the occurrence of motor fibers in 331 sural nerves of 207 individuals. We found motor fibers in 15 nerves (4.5%) or in 13 individuals (6.2%). The identification of motor fibers in the sural nerve before nerve biopsy has important implications for the interpretation of pathologic findings.     

Vagal, sympathetic and somatic sensory inputs to upper cervical (C1-C3) spinothalamic tract neurons in monkeys

1. Myocardial ischemia activates vagal and sympathetic cardiac afferent fibers. The purpose of this study was to determine a neuro physiological basis for cardiac pain referred to C1-C3 somatic dermatomes. We hypothesized that afferent fibers traveling in vagal or sympathetic nerves transmit nociceptive information to C1-C3 spinothalamic tract (STT) neurons. 2. Electrical stimulation of the left stellate ganglion to excite cardiopulmonary sympathetic afferent fibers increased extracellular activity of 44 of 77 C1-C3 STT neurons examined in 33 anesthetized male monkeys (Macaca fascicularis); responses increased as stimulus strength increased. Additionally, this stimulus inhibited 5 cells, increased/decreased activity of 2 cells, and did not affect 26 cells. 3. Electrical stimulation of the left (ipsilateral) thoracic vagus nerve excited 41 of 78 C1-C3 STT neurons, inhibited 4 neurons, increased/decreased activity of 2 neurons, and did not affect 31 neurons. Responses increased with increasing stimulus strength Contralateral vagal stimulation excited 7 of 39 cells tested, inhibited 4 cells and did not affect 28 cells. 4. Effects of stimulating one or more vagal branches were examined on 22 C1-C3 STT neurons excited by input from left thoracic vagus nerve. Stimulation of the cardiac branch excited 11 of 16 cells tested; stimulation of the recurrent laryngeal nerve excited 11 of 18 cells; stimulation of vagal fibers just rostral to the diaphragm excited 8 of 19 cells. 5. Excitatory somatic receptive fields ranged from small ipsilateral fields to large, sometimes bilateral or noncontinuous fields. Many fields included the ipsilateral neck and/or inferior jaw. Thirty-nine of 74 neurons examined were wide dynamic range (WDR), 21 were high threshold (HT), 6 were low threshold (LT), and 8 did not respond to brushing or noxious pinching of somatic tissues. Most (38 of 39) WDR cells responded to stimulation of the stellate ganglion or vagal fibers, as did 18 of 21 HT cells, 3 of 6 LT cells, and 2 of 8 cells unresponsive to brush or pinch stimuli. 6. Results of this study supported the concept that vagal and/ or sympathetic afferent activation of C1-C3 STT neurons might provide a neural mechanism for referred pain that originates in the heart or other visceral organs but is perceived in the neck and jaw region. Additionally, C1-C3 STT neurons processed sensory information from widespread regions of the body.     

Morphometric study of myelinated fibers in human cervical spinal cord white matter

STUDY DESIGN: Using human autopsy spinal cord specimens, morphologic measurements of myelinated nerve fibers were performed, focusing on the regions that include the main white matter conduction paths. The hemilateral spinal cord morphology was also measured, and its relation with the component myelinated nerve fibers determined. OBJECTIVES: To determine the relation between spinal cord transverse area in the normal lower cervical spine, the site most vulnerable to chronic compressive myelopathy, and myelinated nerve fibers. SUMMARY OF BACKGROUND DATA: Considerable interindividual variation normally is observed in the morphology of the spinal cord transverse area. The influence of this variation on the composition of the white matter myelinated nerve fibers is obscure. METHODS: The C7 segments from seven cadavers were resected, and from magnified photographs of paraffin-embedded specimens, the hemilateral spinal cord area and funicular area were measured. Nerve fiber morphology was measured using Epon-embedded specimens. Three regions that included the main conduction paths were sampled, and magnified photographs obtained. The nerve fiber transverse morphology was measured using the ellipse conversion method, and the myelinated nerve density and fiber area were determined. RESULTS: Marked interindividual variations were found in both the hemilateral spinal cord transverse area and funicular area. A positive correlation was noted between the two, with the spinal cord transverse area large in the cases with a large funicular area. For fiber density and area, histograms were constructed that showed characteristic distribution patterns in each region. By dividing each region into two components (i.e., small- and large-diameter fibers), it was found that the interindividual variation in large-diameter fiber density was small, clarifying that the absolute number of large-diameter fibers compared to fiber density is more strongly dependent on the funicular area. CONCLUSIONS: The absolute number of large-diameter myelinated fibers is smaller in cross-sections of thin as compared to those of thick spinal cord. When elucidating the pathophysiology of compressive myelopathy, it is necessary to study not only the circumstances surrounding the spinal cord, but this kind of factor intrinsic to the spinal cord itself.