Wallerian degeneration

Wallerian degeneration is the process of antegrade degeneration of the axons and their accompanying myelin sheaths following proximal axonal or neuronal cell body lesions. It may result following neuronal loss due to cerebral infarction, trauma, necrosis, focal demyelination, or hemorrhage

In cases of cerebral infarction, Wallerian degeneration appears in the chronic phase (>30 days).

It is usually classified into four stages:

  1. degeneration of the axons and myelin sheaths with mild chemical changes (0-4 weeks)
  2. rapid destruction of myelin protein fragments that were already degenerated, lipids remain intact (4-14 weeks)
  3. gliosis replaces the degenerated axons and myelin sheaths, myelin lipid breakdown (>14 weeks)
  4. atrophy of the white matter tracts (months to years)

CT is not as sensitive as MRI, and Wallerian degeneration is generally observed only in its chronic stage. It is seen as a contiguous tract of gliosis leading from a region of cortical or subcortical neuronal injury towards the deep cerebral structures, along the expected topographical course of the involved white matter tract.

Corresponding stages have been described on MRI.

  • T1
    1. no changes
    2. T1 hyperintense
    3. T1 hypointense
    4. brainstem atrophy with or without hypointensity
  • T2
    1. no changes
    2. T2 hypointense
    3. T2 hyperintense
    4. brainstem atrophy
  • DWI

High signal on DWI and low signal on ADC have been demonstrated along the affected white matter tracts, from the first days after insult until 8 months after 7.

It is named after the English neurophysiologist Augustis Volney Waller (1816-1870), who described the process in 1850 6.

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Article information

rID: 18998
Synonyms or Alternate Spellings:
  • Waller degeneration
  • Wallerian degeneration (WaD)

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Cases and figures

  • Case 1
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  • Case 2: left corticospinal tract
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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