Morphological and Ultrastructural Analysis of the Watershed Zones After Stripping of the Vasa Nervorum

Peripheral nerve trunks are well-vascularized structures where a well-developed collateral system may compensate for local vascular damage. Vasculitis in nerve has a predilection for epineurial vessels and causes to the peripheral neuropathy, which is a major clinical feature of primary and secondary systemic vasculitides. In the present study, the goal was to simulate the vasculitic neuropathy in rat sciatic nerve and to investigate the watershed zones after stripping of the epineural vessels of the sciatic nerve. Sciatic function index values, light and electron microscopic evaluations of the experimental sciatic nerve suggested that the sciatic nerve was normal except for some watershed zones located in the peripheral part of the nerve. Although there is abundant collateral circulation in the peripheral nerve, distribution of the vessels of the watershed zones as observed in the present study should be elucidated by further studies.     

周围神经卡压伤与神经微循环的改变

目的 研究主动运动对周围神经挤压伤后神经微循环以及功能恢复的影响。方法 大鼠坐骨神经卡压模型建模后分为实验组和对照组,实验组术后一周开始每天进行游泳训练,对照组自由活动。术后3周进行坐骨神经功能指数（SFI）评价、激光多普勒血流仪检测、CD34免疫组化、轴突、髓鞘染色。结果 ①游泳训练组坐骨神经功能指数明显高于自由活动组（P＜0.01）。②实验组与对照组血流量比较无显著差异（P＞0.05）。③CD34免疫组化染色显示实验组神经平均微血管密度高于对照组（P＜0.05）。④轴突、髓鞘染色：实验组再生轴突直径、髓鞘厚度、单位面积的轴突数目均大于对照组（P＜0.05）。结论 主动运动能促进受压神经功能恢复、血管再生,但对于神经血流量没有影响。     

Amelioration of diabetic peripheral neuropathy by implantation of hematopoietic mononuclear cells in streptozotocin-induced diabetic rats

This study was performed in order to evaluate the angiogenic effect of implantation of either peripheral blood mononuclear cells (PBMNCs) or bone marrow mononuclear cells (BMMNCs) on diabetic peripheral neuropathy. Streptozotocin (50 mg/kg) was injected intravenously into 6-week-old male Lewis rats. Four weeks after the induction of diabetes, 6 x 10(7) of PBMNCs or 1 x 10(8) of BMMNCs were implanted into the left hindlimb muscle. Motor nerve conduction velocity (MNCV) was monitored before and after implantation. At the end of the experiment, bilateral nerve blood flow (NBF) was measured by laser Doppler and the number of vessels in the sciatic nerves quantified by Factor VIII staining of the sections. Diabetes resulted in an approximately 20% reduction (P < 0.01) in sciatic MNCV. Four weeks after implantation, MNCV was improved by 54% with PBMNCs and by 67% with BMMNCs (both P < 0.01). Moreover, the effects of implantation were almost abolished by administration of VEGF-neutralizing antibody. Sciatic NBF was reduced by approximately 50% by diabetes (P < 0.05). This reduction in perfusion was improved by 74% by implantation of PBMNCs and by 62% by implantation of BMMNCs (P < 0.05 and P < 0.01, respectively). These effects were observed only in the implanted limb. Immunohistochemical staining of sciatic nerve sections for Factor VIII showed no significant increase in the number of vessels in the sciatic nerve following implantation of either PBMNCs or BMMNCs. These data suggest that implantation of hematopoietic mononuclear cell fractions is associated with an improvement in MNCV as a result of arteriogenic effects in the sciatic nerve, and that VEGF may contribute to this effect. This improvement occurred in the absence of angiogenesis. Implantation of these cell fractions may therefore be a potential new therapeutic method for treating diabetic peripheral neuropathy.     

Morphometric analysis of the peripheral neuropathy of AIDS

A morphometric study of the peripheral nervous system at autopsy was undertaken in 11 AIDS patients and 10 controls. The left L4, L5, and S1 dorsal root ganglia (DRG) and samples of the sciatic nerve at the buttock, tibial nerve at the knee, and sural nerve at the ankle were collected. Indices of neuronal/axonal degeneration and of segmental demyelination/remyelination were measured at each level. The small number of cases and evidence of neuropathy in a number of the control cases resulted in statistical significance for only a limited number of comparisons. Nodules of Nageotte in the DRG were increased fivefold in AIDS cases compared with controls, and axonal degeneration in single-teased nerve fibers was increased 9-fold in the sciatic nerve, 28-fold in the tibial nerve, and 12-fold in the sural nerve. The ratios of AIDS to controls for the density of remaining DRG neurons and large myelinated axons were reduced to 0.71 in the DRG, 0.84 in the sciatic nerve, 0.84 in the tibial nerve, and 0.66 in the sural nerve. Axonal regeneration in single-teased nerve fibers was increased threefold at the sciatic nerve level in AIDS, but was markedly reduced at distal levels. Acute segmental demyelination in single-teased nerve fibers was present to a greater extent than in controls at all levels of the peripheral nerves in the AIDS cases. Remyelinating fibers were increased compared with controls only in the proximal sciatic nerve. No case showed the changes of cytomegalovirus infection. In a parallel immunohistochemical study of these AIDS peripheral nerves, T-cell and macrophage infiltration, with cytokine expression, was demonstrated. The pathological process in the neuropathy of terminal AIDS appears to be a multifocal immunologically mediated inflammatory disease, with increased density of macrophages and T cells at all levels of the peripheral nervous system, producing segmental demyelination and axonal degeneration. Reparative processes (axonal regeneration and remyelination) occurred only at the most proximal levels of the nerves. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:1188–1195, 1998.     

Ischemic neuropathy

Ischemia plays an important role in the development of neuropathies associated with various disorders, such as peripheral vascular occlusive diseases, necrotizing vasculitides, diabetes mellitus and nerve compression or trauma. Although a multiple mononeuropathy or an asymmetrical polyneuropathy is the usual clinical presentation of ischemic neuropathy, some patients present with a neuropathy that is mainly distal and symmetrical. Pathologically, nerve ischemia results in focal or multifocal central fascicular or sector fiber degeneration. These ischemic lesions tend to begin at mid-upper arm or midthigh level, which is the watershed zone of poor perfusion, and become more diffuse distally. Nerve ischemia at the level of distal small fascicles often induces sub-perineurial crescent lesion rather than central fascicular fiber degeneration. Physiologically, reduced nerve blood flow with endoneurial hypoxia has been demonstrated in experimental diabetic and galactose neuropathies. Endoneurial ischemia/hypoxia in galactose neuropathy appears to be due to increased intercapillary distances and constriction of trans-perineurial vessels resulting from endoneurial edema. Although acute ischemic neuropathy has been well investigated, little is known about functional or structural responses of peripheral nerve to chronic ischemia.     

Expansion of spinal cord primary sensory afferent projection following combined sciatic nerve resection and saphenous nerve crush: a horseradish peroxidase study in the adult rat

Transganglionic transport of horseradish peroxidase was used to study the potential for collateral sprouting of saphenous nerve afferent fibers in the lumbar dorsal horn of the adult rat following (1) combined unilateral saphenous nerve crush and ipsilateral sciatic nerve resection, (2) unilateral saphenous nerve crush, and (3) unilateral sciatic nerve resection. The saphenous nerve on the nonlesioned contralateral side served as control. Eight weeks after the lesion(s) the animals were subjected to bilateral application of horseradish peroxidase to the saphenous nerves. The distribution of the ensuing labeling in the superficial dorsal horn was subsequently mapped. Combined saphenous nerve crush and sciatic nerve resection resulted in expansion of the saphenous nerve projection area in the dorsal horn when compared to the nonlesioned control side (mean = 13%, P less than 0.05). No expansion of the saphenous nerve projection was found following isolated saphenous nerve crush or sciatic nerve resection, respectively (P greater than 0.05). The findings indicate that in the adult rat, central processes of primary sensory neurons which are regenerating their peripheral processes can extend collateral sprouts into adjacent projection areas in the superficial dorsal horn subjected to previous deafferentation by peripheral nerve resection.     

Focal and generalized peripheral nerve dysfunction in spinal cord-injured patients.

SUMMARY: The present study was undertaken to quantitate the incidence and clinical patterns of peripheral nerve dysfunction distal to the level of injury in patients with spinal cord injury (SCI). Through retrospective analysis, SCI patients were identified after referral for neurophysiologic investigation of new neuropathic symptoms. In total, peripheral nerve or nerve root lesions developed in 34 SCI patients, most commonly within the first year after SCI. Carpal tunnel syndrome was the most common upper-limb neuropathy (34%); sciatic neuropathy was the most common lower-limb abnormality (8.5%). A significant proportion of SCI patients had neurophysiological evidence of generalized peripheral nerve dysfunction, specifically axonal neuropathy (18%). Tetraplegic patients developed more frequent peripheral nerve lesions than paraplegics. Although most SCI patients presented within 4 years of their original injury, in a more chronic population of SCI patients that developed neuropathy 5 years after injury, 60% had evidence of coexistent syrinx formation. Maintenance of peripheral nerve function is a critical issue in all acute SCI and rehabilitation units, particularly in the context of spinal cord neuronal regeneration projects.     

Pathologic classification of a late-onset peripheral neuropathy in a spontaneous Labrador retriever dog model

Late-onset peripheral neuropathy (LPN) is a heritable canine neuropathy commonly found in Labrador retrievers and is characterized by laryngeal paralysis and pelvic limb paresis. Our objective was to establish canine LPN as a model for human hereditary peripheral neuropathy by classifying it as either an axonopathy or myelinopathy and evaluating length-dependent degeneration. We conducted a motor nerve conduction study of the sciatic and ulnar nerves, electromyography (EMG) of appendicular and epaxial musculature, and histologic analysis of sciatic and recurrent laryngeal nerves in LPN-affected and control dogs. LPN-affected dogs exhibited significant decreases in compound muscle action potential (CMAP) amplitude, CMAP area, and pelvic limb latencies. However, no differences were found in motor nerve conduction velocity, residual latencies, or CMAP duration. Distal limb musculature showed greater EMG changes in LPN-affected dogs. Histologically, LPN-affected dogs exhibited a reduction in the number of large-diameter axons, especially in distal nerve regions. In conclusion, LPN in Labrador retrievers is a common, spontaneous, length-dependent peripheral axonopathy that is a novel animal model of age-related peripheral neuropathy that could be used for fundamental research and clinical trials.     

Segmental demyelination in the peripheral nerves of mice affected by a hereditary neuropathy (dystonia musculorum)

Summary A teased fibre and electron-microscopical study was carried out on the sciatic nerves of mice affected with the peripheral neuropathy in dystonia musculorum. Widespread segmental demyelination was present in all the nerves. Focal axon swellings were also seen, but were relatively scarce and similar in appearance to post-traumatic reactive swellings. The variability of dystonic internodal lengths was indicative of segmental demyelination rather than axonal degeneration. The largely motor fibres of the phrenic nerve were seen to undergo a similar degenerative process, but with a later onset and more gradual progression. Segmental demyelination was found to be present before axon swellings and other degenerative changes became visible in developing phrenic nerve. Demyelination is thus an important pathological process in dystonia musculorum, and the present observations are consistent with a primary segmental demyelinating disorder in dystonic peripheral nerve.     

Galanin and its receptor system promote the repair of injured sciatic nerves in diabetic rats

Various studies have reported that galanin can promote axonal regeneration of dorsal root ganglion neuronsin vitro and inhibit neuropathic pain. However, little is known about its effects on diabetic peripheral neuropathy, andin vivo experimental data are lacking. We hypothesized that repeated applications of exogenous galanin over an extended time frame may also repair nerve damage in diabetic peripheral neuropathy, and relieve pain in vivo. We found that neuropathic pain occurred in streptozotocin-induced diabetic rats and was more severe after sciatic nerve pinch injury at 14 and 28 days than in diabetic sham-operated rats. Treatment with exogenous galanin alleviated the neuropathic pain and promoted sciatic nerve regeneration more effectively in diabetic rats than in non-diabetic rats after sciatic nerve pinch injury. This was accompanied by changes in the levels of endogenous galanin, and its receptors galanin receptor 1 and galanin receptor 2 in the dorsal root ganglia and the spinal dorsal horn when compared with nerve pinch normal rats. Our results show that application of exogenous galanin daily for 28 days can promote the regeneration of injured sciatic nerves, and alleviate neuropathic pain in diabetic rats.     

Peripheral Neuropathy: Assessment of Proximal Nerve Integrity By Diffusion Tensor Imaging

Introduction: We investigated the utility of diffusion tensor imaging (DTI) for detecting neuropathic changes in proximal nerve segments in patients with peripheral neuropathy. Methods: Twenty‐one individuals with (n = 11) and without (n = 10) peripheral neuropathy underwent DTI of a defined sciatic nerve segment. Patients and controls were evaluated by clinical examination and nerve conduction studies at baseline and 6 months after the initial DTI scan. Results: The mean fractional anisotropy (FA) value was significantly lower in sciatic nerves from patients with peripheral neuropathy as compared with controls. Sciatic nerve FA values correlated with clinical disability scores and electrophysiological parameters of axonal damage at baseline and 6 months after MRI scan. Conclusions: DTI‐derived FA values are a sensitive measure to discriminate healthy from functionally impaired human sciatic nerve segments. DTI of proximal nerve segments may be useful for estimating the proximal axonal degeneration burden in patients with peripheral neuropathies. Muscle Nerve 48 : 889–896, 2013     

Regional perfusion in normal and ischemic rat sciatic nerves

We measured regional blood flow in rat sciatic-posterior tibial nerve using an iodo-[14C]antipyrine autoradiographic technique. Average flow was 12.1 +/- 3.3 ml/100 gm/min, considerably less than that of both gray and white matter structures in the cerebral hemispheres. Perfusion was homogeneous along the proximal-distal extent of this nerve and along its radial axis. Acute occlusion of the femoral artery reduced regional sciatic blood flow. Flow was especially depressed within the endoneurial core of the proximal posterior tibial branch, which lies in a watershed zone between adjacent segmental arterial fields. The topography of the arterial supply to nerves and their abundant collateral circulation may explain the centrifascicular distribution of nerve infarcts, and in part can account for the apparent resistance of peripheral nerves to ischemia.     

Sex differences in the manifestation of peripheral diabetic neuropathy in gonadectomized rats: a correlation with the levels of neuroactive steroids in the sciatic nerve

Clinical observations suggest a sex-dimorphism in the incidence and symptomatology of diabetic neuropathy, but this possible gender effect has never been investigated in detail in a well-characterized experimental model such as streptozotocin (STZ)-induced diabetes. Therefore, in this study we have compared with a multimodal set of tests the impact of diabetes on the sciatic nerve in male and female rats. To assess whether sex-dimorphism in peripheral diabetic neuropathy is dependent on gonadal hormones we have also analyzed the effect of ovariectomy and orchidectomy on the sciatic nerve of STZ-diabetic rats. Nerve conduction velocity (NCV), Na⁺,K⁺-ATPase activity, expression of myelin proteins, thermal sensitivity and reactive oxygen species production were similarly affected in male and female animals by STZ. However, ovariectomy, but not orchidectomy, significantly counteracted STZ-induced alterations on NCV, Na⁺,K⁺-ATPase activity, and expression of myelin proteins. This effect of ovariactomy was associated to an increase in the levels of neuroactive steroids, such as dehydroepiandrosterone, testosterone and dihydrotestosterone, in the sciatic nerve of diabetic rats. These neuroactive steroids have been demonstrated to be protective agents in this experimental model of diabetic neuropathy. However, their efficacy has been so far tested only in male animals. Therefore, the present data might represent an important background to evaluate their efficacy also in female diabetic animals.     

Regional differences in severity of cadmium-induced lesions in the peripheral nervous system in mice

Summary Adult mice were injected s. c. with a single toxic dose of cadmium chloride. After intervals of 24 h to 7 days, various peripheral ganglia and the sciatic nerve were examined by light and electron microscopy for injurious effects of cadmium on blood vessels, nerve cells, axons and the connective tissue sheaths. In addition, horseradish peroxidase (HRP) was used to detect changes in the permeability of blood vessels, perineurium, and cellular membranes.Endothelial cell damage with hemorrhages were constant findings in sensory ganglia. In the superior cervical ganglion and the sciatic nerve, hemorrhages and interstitial edema occured in about 50% of the animals. No vascular lesions were present in the celiac ganglion.Damage to nerve cells and axons occured in sensory but not in sympathetic ganglia. Intravenously injected HRP entered the cytoplasm of several neurons in the sensory ganglia in a diffuse manner, indicating damage to their cell membranes with loss of selective permeability. The axoplasm of some myelinated axons was also stained by peroxidase.Only minor ultrastructural changes were observed in the perineurial cells of the sciatic nerve or peripheral ganglia in cadmium-treated mice. The perineurial diffusion barrier to peroxidase in the sciatic nerve and the superior cervical ganglion was not affected by the cadmium injection.Acute cadmium intoxication in adult mice therefore appears to leave the perineurial structure and permeability to HRP unaffected, whereas the extent of vascular damage differs in different regions of the peripheral nervous system without any obvious relation to the normal permeability to macromolecules. This variation in the intensity of vascular lesions may reflect a functional difference between endothelial cells in different regions of the peripheral nervous system, but the precise nature of this hypothetical difference is unk nown.     

Gene expression of antioxidant enzymes in experimental diabetic neuropathy

Chronic hyperglycemia results in a large deficit in nerve blood flow. Both autoxidative- and ischemia-induced lipid peroxidation occurs, with resultant peripheral sensory neuropathy in streptozotocin-induced diabetes in the rat. Free radical defenses, especially involving antioxidant enzymes, have been suggested to be reduced, but scant information is available on chronic hyperglycemia. We evaluated the gene expression of glutathione peroxidase, catalase, and superoxide dismutase (cuprozinc and manganese separately) in L4,5 dorsal root ganglion (DRG) and superior cervical ganglion, as well as enzyme activity of glutathione peroxidase in DRG and sciatic nerve in experimental diabetic neuropathy of 3 months and 12 months durations. We also evaluated nerve electrophysiology of caudal, sciatic-tibial, and digital nerves. A nerve conduction deficit was seen in all nerves in experimental diabetic neuropathy at both 3 and 12 months. Gene expression of glutathione peroxidase, catalase, cuprozinc superoxide dismutase, and manganese superoxide dismutase were not reduced in experimental diabetic neuropathy at either 3 or 12 months. Catalase mRNA was significantly increased in experimental diabetic neuropathy at 12 months. Glutathione peroxidase enzyme activity was normal in sciatic nerve. We conclude that gene expression is not reduced in peripheral nerve tissues in very chronic experimental diabetic neuropathy. Changes in enzyme activity may be related to duration of diabetes or due to post-translational modifications.     

Collateral sprouting of sensory axons in the glabrous skin of the hindpaw after chronic sciatic nerve lesion in adult and neonatal rats: a morphological study

The anterograde transport of wheat germ agglutinin-horseradish peroxidase conjugate was used to study the normal distribution of sensory nerve axons in the plantar skin of the rat hindlimb and at various times after chronic sciatic nerve injury in adult and neonatal rats. In adults, thin saphenous nerve axons were found in a small area laterally to the normal saphenous nerve territory 2–24 weeks after sciatic nerve lesion. In neonatal rats, at 6 and 10 weeks after sciatic nerve injury thin sapherous nerve axons were found almost or all over the sole of the foot, respectively, and in all 5 toes. At longer survival times, the area innervated by saphenous nerve axons became smaller. However, this area was now occupied by thin, as well as coarse axons. When adult animals were subjected to saphenous nerve crush simultaneously with the sciatic nerve lesion, thin, as well as coarse, nerve axons were found laterally to the normal saphenous nerve territory. The findings indicate that thin cutaneous sensory axons of adult mammals can extent collateral sprouts in glabrous skin for a short distance. This capacity appears to be greater in neonatally lesioned animals, where it is present for coarse cutaneous sensory axons as well. However, after neonatal nerve injury collateral sprouts seem to disappear from the initially most distally reinnervated area. Regenerating sensory axons in adult rats seem to have a greater capacity for collateral sprouting than intact axons. Coarse and thin cutaneous sensory axons could be found in this instance. In all instance a great part of the plantar skin remained denervated, suggesting that there is an upper limit for the territory which can be maintained by cutaneous sensory neurons reinnervating glaborous skin.     

Submodality-Selective Hyperalgesia Adjacent to Partially Injured Sciatic Nerve in the Rat is Dependent on Capsaicin-Sensitive Afferent Fibers and Independent of Collateral Sprouting or a Dorsal Root Reflex

We studied submodality dependence of sensory changes produced by unilateral ligation of the sciatic or the saphenous nerve in the rat. We focused especially on sensory changes in the skin area adjacent to the innervation area of the injured nerve. Moreover, we examined the roles of capsaicin-sensitive nociceptive fibers, collateral sprouting and a dorsal root reflex in sensory changes observed behaviorally. Assessment of sensory changes was performed by a pattern of behavioral tests: hot-plate test and hindlimb withdrawal responses induced by radiant heat, hot-water bath, innocuous mechanical stimuli, and noxious mechanical stimuli. In one group, the saphenous nerve ipsilateral to the sciatic ligation was topically treated with capsaicin (1%) at the time of the surgery. A proximal stump of a saphenous nerve strand was orthodromically stimulated to induce a dorsal root reflex (an antidromic volley) in nociceptive fibers of the saphenous nerve trunk. For visualization of plasma extravasation induced by a dorsal root reflex, a dye-labeling (Evans blue) technique was used. A collateral sprouting of nociceptive fibers of the uninjured saphenous nerve was evaluated by determining the plasma extravasation response induced by antidromic stimulation of the saphenous nerve. Three and 10 days following the sciatic constriction injury, the hindlimb withdrawal threshold evoked by noxious mechanical stimulation of the medial side of the paw (the innervation are of the intact saphenous nerve) was significantly decreased. There was no corresponding thermal hyperalgesia adjacent to the injured sciatic nerve. Chronic constriction of the saphenous nerve did not produce any significant hyper- or hypoalgesia to mechanical or thermal stimulation of the uninjured sciatic nerve area. Topical treatment of the ipsilateral (intact) saphenous nerve at the time of the sciatic nerve ligation completely prevented the development of mechanical hyperalgesia in the medial side of the paw (the innervation area of the saphenous nerve). No dorsal root reflex in nociceptive fibers mediating the adjacent hyperalgesia could be evoked. No collateral sprouting of the uninjured nociceptive fibers of the saphenous nerve was observed. The results indicate that the constriction injury of the sciatic nerve produced a selective hyperalgesia to mechanical stimulation in the innervation area of the neighboring saphenous nerve. At the peripheral level, the mechanical hyperalgesia adjacent to the innervation area of the injured nerve was mediated by capsaicin-sensitive nociceptive fibers. Collateral sprouting of nociceptive fibers from the uninjured to the injured innervation area did not contribute to the present sensory findings. The sciatic nerve injury did not induce a dorsal root reflex in nociceptive fibers innervating the hyperalgesic saphenous nerve area.     

Novel sites of aldose reductase immunolocalization in normal and streptozotocin-diabetic rats

Glucose metabolism by aldose reductase (AR) is implicated in the pathogenesis of many diabetic complications, including neuropathy. We have re-evaluated the distribution of AR in the sciatic nerve and dorsal root ganglion (DRG) of normal rats, expanded these observations to describe the location of AR in the spinal cord and footpad skin, and investigated whether diabetes alters the distribution of AR. In sciatic nerve, AR was restricted to cytoplasm of myelinated Schwann cells and endothelial cells of epineurial, but not endoneurial, blood vessels. AR immunoreactivity (IR) was present in satellite cells in the DRG. In skin, AR-IR was detected in vascular endothelial cells, Schwann cells of myelinated fibers, and axons of perivascular sympathetic nerves. AR was localized selectively to oligodendrocytes of the white matter of spinal cord. The distribution of AR-IR in sciatic nerve, DRG, skin, and spinal cord was not altered by up to 12 weeks of streptozotocin-induced diabetes. Identification of perineuronal satellite cells, oligodendrocytes, and perivascular sympathetic nerves as AR-expressing cells reveals them as cellular sites with the potential to contribute to diabetic neuropathy.     

Gabapentin reverses mechanical allodynia induced by sciatic nerve ischemia and formalin-induced nociception in mice

The anticonvulsant drug gabapentin has been demonstrated to alleviate symptoms of painful diabetic neuropathy as well as other types of neuropathic pain. The aim of the present study was to investigate the effect of gabapentin in a recently developed mouse model of peripheral neuropathy. This model is based on a photochemical ischemic lesion of the sciatic nerve generated by laser-induced activation of the photosensitizing dye erythrosin B. Following laser irradiation of the sciatic nerve for 2, 5, or 10 min, tactile allodynia was observed during at least 3 weeks. The degree of allodynia was most marked following 10 min of irradiation. Subcutaneous administration of gabapentin [175-300 micromol/kg ( approximately 30-51 mg/kg), cumulative doses, at 1-h intervals] significantly reversed tactile allodynia induced by 10-min laser irradiation. The maximal dose of gabapentin increased the withdrawal threshold from approximately 0.55 to approximately 1.85 g (i.e., about 77% of the threshold in normal animals, approximately 2.4 g). Gabapentin did not affect the tactile withdrawal threshold in intact animals. A dose of gabapentin (100 micromol/kg, sc) that had no effect on allodynia was found to significantly reduce the pain behavior during phase 2 of the formalin test. The present study demonstrates that systemic administration of gabapentin suppresses both allodynia induced by an ischemic lesion of the sciatic nerve and pain behavior in the formalin test.     

Pure peroneal intraneural ganglion cyst ascending along the sciatic nerve

Peroneal nerve entrapment is most commonly seen in the popliteal fossa. It is rarely caused by a ganglion. Intraneural ganglia, although uncommon and seldom cause serious complications, are well recognized and most commonly affect the common peroneal (lateral popliteal) nerve. Ganglionic cysts developing in the sheath of a peripheral nerve or joint capsule may cause compression neuropathy. The differential diagnosis should involve L5 root lesions, posttraumatic intraneural hemorrhage, nerve compression near the tendinous arch located at the fibular insertion of the peroneal longus muscle and nerve-sheath tumors. We present a unique case of a pure intraneural ganglion of the common peroneal nerve ascending along the sciatic nerve. This case underscores the importance of consideration of an intraneural ganglion cyst with sciatic nerve involvement.