Wallerian degeneration

Case contributed by Dr Charlie Chia-Tsong Hsu


History of TIAs.

Patient Data

Age: 70
Gender: Male

Coronal T2 and axial FLAIR images demonstrate an established/old lacunar infarct in the left centrum semi-ovale. Evidence of Wallerian degeneration with hyperintensity of the left corticospinal tract from centrum semi-ovale through the internal capsule and cerebral peduncle to the level of mid pons. The left corticospinal tract is yet to undergo atrophy.

Case Discussion

Wallerian degeneration can be observed following stroke, brain tumor, brain surgery or radiation and trauma. It typically affects the descending corticospinal tract but long association and commissural fibers can also be affected. In the acute phase the affect fiber tract can demonstrate restricted diffusion or enhancement. More typically in the acute and subacute phases the affected fiber tract demonstrates T2 and FLAIR hyperintensities. In the chronic phase the fiber tract will demonstrate atrophy, however, the T2 and FLAIR hyperintensities may persist for months after the initial inciting event. 

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Case information

rID: 25707
Published: 4th Nov 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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