Sheaths of the spinal nerve roots

Pettersson, Christer

doi:10.1007/bf00227759

Cited by 13 publications

(6 citation statements)

References 30 publications

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“…In an experimental study, intrathecally injected fluorescent tracer entered the spinal cord grey and white matter [26]. In an in vivo study also on rodents, macromolecular and ionic tracers injected into the subarachnoid space entered the dorsal and ventral roots indicating that their connective tissue sheath and their pia mater covering are permeable [30]. MRI investigations of HZ patients showed enhancement of ventral and dorsal roots that correspond to segmental muscle paresis and dermatomal distribution of skin rash in the lower limb [31] and the upper limb [32] supporting the view that HZ motor paresis may be due to anterior root radiculopathy.…”

Section: Discussion Of Motor System Involvement In Hzmentioning

confidence: 99%

The Neuroanatomical Basis of Unfamiliar Presentations of Herpes Zoster: A Review and A Case Report

N¹,

N²

2023

Clin Med Rev Case Rep

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Herpes zoster (HZ, shingles) is caused by reactivated varicella zoster virus, that travels along the peripheral branches from its dormant location in neurons of spinal and cranial sensory ganglia. HZ is well known for its skin vesicular eruptions and severe sensory neuropathy. Over the years, reports have described the occurrence of segmental paresis of skeletal muscles and the involvement of the large and small intestine, clinically resembling intestinal obstruction.The spread of the virus to the motor and autonomic nervous systems is discussed here based on the neuroanatomical pathways and with reference to the unfamiliar manifestations observed in a recently hospitalised HZ case.A 66-year-old male of Egyptian descent, initially developed muscle aches in the right loin, altered touch sensation in the overlying skin and bouts of stabbing pain. These were followed on day two by the appearance of an abdominal wall swelling, 10 × 12 cm, in the right lumbar region. On day four, he complained of nausea, bloating, abdominal distension, and constipation. Examination revealed reduced intestinal sounds, and CT scans showed distended intestine with gas and fluid levels. On day five, vesicular skin rash characteristic of HZ appeared along dermatomes of the right spinal nerves T10 to L1.Surgeons and medical practitioners should be made aware of these unfamiliar presentations of HZ, especially as these may precede the archetypal skin rash, to evade unnecessary surgical intervention.

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Section: Discussion Of Motor System Involvement In Hzmentioning

confidence: 99%

The Neuroanatomical Basis of Unfamiliar Presentations of Herpes Zoster: A Review and A Case Report

N¹,

N²

2023

Clin Med Rev Case Rep

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“…ENF is similar in composition to CSF, and is thought to maintain proper pressure regulation for peripheral nerve health (17). However, the site of production for ENF is not well defined (11)(12)(13)(14)17). The prevailing understanding that CSF flow is restricted to the CNS was established by a variety of vital dye studies using tracers that relied on their inherent properties for detection (not able to be enhanced for more sensitive detection) (1, 4,5,22).…”

Section: Discussionmentioning

confidence: 99%

“…These studies assessed CSF flow by following tracer distribution patterns. They often described staining "cuffs" forming at the transition from CNS to peripheral nerves with little evidence for tracer flow to peripheral nerves (11)(12)(13)(14). Many of these studies have suggested the possibility of CSF flow into peripheral nerves, but the limitations of the vital dyes used, and lack of subcellular resolution did not allow for firm conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies identified the accumulation of dyes and tracers at the subarachnoid angle, a point where the arachnoid mater folds back on itself and becoming continuous with the dura creating a “cul-de-sac” where peripheral nerves branch exit from the CNS (4, 11, 12, 14). Our results reveal 1.9nm nanogold infused into CSF entering the PNS through the transition/root attachment zone (RAZ) (Fig 1-5, S9, S10).…”

Section: Discussionmentioning

confidence: 99%

“…The endoneurium surrounding the Schwann cells that covers peripheral axons contains fluid similar in composition to CSF, yet the origins of this fluid are debated (17,18). Previous vital dye studies showed dye collecting in a cuff around the roots of peripheral nerves where they emerge from the CNS following infusion into the subarachnoid spaces, but to date no conclusive evidence of CSF flow throughout the peripheral nervous system (PNS) has been demonstrated (2,(10)(11)(12)(13)(14)17).…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid Flow Extends to Peripheral Nerves

Ligocki,

Vinson,

Yachnis

et al. 2023

Preprint

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Cerebrospinal fluid (CSF) is an aqueous solution responsible for nutrient delivery and waste removal for the central nervous system (CNS). The three-layer meningeal coverings of the CNS support CSF flow. Peripheral nerves have an analogous three-layer covering consisting of the epineurium, perineurium, and endoneurium. Peripheral axons, located in the inner endoneurium, are bathed in “endoneurial fluid” similar to CSF but of undefined origin. CSF flow in the peripheral nervous system has not been demonstrated. Here we show CSF flow extends beyond the CNS to peripheral nerves in a contiguous flowing system. Utilizing gold nanoparticles, we identified that CSF is continuous with the endoneurial fluid and reveal the endoneurial space as the likely site of CSF flow in the periphery. Nanogold distribution along entire peripheral nerves and within their axoplasm suggests CSF plays a role in nutrient delivery and waste clearance, fundamental aspects of peripheral nerve health and disease.One Sentence SummaryCerebrospinal fluid unites the nervous system by extending beyond the central nervous system into peripheral nerves.

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Vascular permeability in the peripheral autonomic and somatic nervous systems: Controversial aspects and comparisons with the blood-brain barrier

Kiernan

1996

Microsc. Res. Tech.

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Endothelium, choroidal epithelium, and arachnoid exclude plasma proteins from most parts of the mammalian central nervous system (CNS). Nerve roots, in contrast, have permeable capillaries and permeable pia‐arachnoid sheaths. Diffusion of plasma proteins into the cerebrospinal fluid is probably prevented by slow bulk flow along a pressure gradient from the subarachnoid space into the veins of the roots. In nerves, the perineurium prevents diffusion of proteins from the epineurium into the endoneurium. Capillaries within fascicles are permeable to macromolecules, though less so than the microvessels of roots and ganglia. Endoneurial vascular permeability is lowest in rats and mice, but even in these species albumin is normally present in the extracellular spaces around the nerve fibers. The so‐called blood‐nerve barrier is not equivalent to the blood‐brain barrier. Capillaries in sensory and sympathetic ganglia are fully permeable to macromolecules, and extravasated protein is in contact with neuronal cell bodies and neurites. An impenetrable perineurium surrounds each ganglion, but serves no obvious purpose when the vessels inside are as permeable as those outside. The enteric nervous system lacks a perineurium, and the neurons in its avascular ganglia and tracts are exposed to extracellular fluid formed by permeable vessels in adjacent tissues of the gut. The reasons for excluding macromolecules from some parts of the nervous system are obscure. Carrier‐mediated transport, which maintains a constant supply of ions, glucose, and other metabolites to cells in the CNS, would be impossible if larger molecules could diffuse freely. Presumably the metabolic needs of ganglia are adequately met by exchange vessels similar to those of nonnervous tissues. Most of the CNS is protected from exogenous toxic substances that bind to plasma proteins. Peripheral neurons and glial cells are damaged by some such substances because of the lack of blood‐tissue barriers. © 1996 Wiley‐Liss, Inc.

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Sheaths of the spinal nerve roots

Cited by 13 publications

References 30 publications

The Neuroanatomical Basis of Unfamiliar Presentations of Herpes Zoster: A Review and A Case Report

The Neuroanatomical Basis of Unfamiliar Presentations of Herpes Zoster: A Review and A Case Report

Cerebrospinal Fluid Flow Extends to Peripheral Nerves

Vascular permeability in the peripheral autonomic and somatic nervous systems: Controversial aspects and comparisons with the blood-brain barrier

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