Download Critical care secrets by Polly E. Parsons MD, Jeanine P. Wiener-Kronish MD PDF

Download Critical care secrets by Polly E. Parsons MD, Jeanine P. Wiener-Kronish MD PDF

By Polly E. Parsons MD, Jeanine P. Wiener-Kronish MD

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14 Apoptosis in contrast to necrosis is an active, programmed pathway in neuronal death, akin to suicide, where the cell actively kills itself. In apoptosis, the cells and nuclei characteristically shrink, cellular organelles stay intact, nuclear chromatin condenses, and DNA fragmentation occurs. Both apoptosis and necrosis can be triggered by exogenous factors such as excitoxins, hyperthermia, free radicals, and radiation. However, cells undergoing death by apoptosis do not produce an inflammatory reaction because they are autodigested by proteases and phagocytosed in a controlled, organized, and programmed sequence of events.

With respect to axonal regeneration and collateral sprouting, there are several anatomical sites where this can occur, as shown in Fig. 1. Axonal regeneration is defined as occurring from the injured axon itself, either from the damaged end or from a more proximal location on the damaged axon. In contrast, collateral sprouting occurs from an undamaged axon, possibly a neighboring axon in the same tract or from an axon in a different tract. The collateral may grow at the injury site or from a remote site.

10,11 Although axonal sprouting and the formation of new neural connections distal to the site of injury are the goals after SCI, there are consequences. Aberrant sensory connections have the ability to form that lead to patients suffering from allodynia and various other forms of potentially devastating chronic pain symptoms. Sixty percent of patients with SCI suffer from some type of chronic pain and state that this pain is their primary complaint even if motor function is severely limited. 13 Future work on the treatment of SCI will focus on reducing inhibitory molecules at the glial scar injury site, leading to increased sprouting from the affected axons.

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