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Onion Bulb Formation of Peripheral Nerve - An Overview

Onion bulb formation refers to a characteristic morphological abnormality that can occur in peripheral nerves as a result of certain pathological conditions. 

The name "onion bulb" is used to describe the appearance of the nerve fibers, which appear as a series of concentric rings around a central axis, resembling the layers of an onion.

Onion bulb formation is typically associated with conditions that result in the abnormal proliferation and/or deposition of Schwann cells, which are the cells that produce myelin in the peripheral nervous system. These conditions include:

1. Charcot-Marie-Tooth disease (CMT): 

CMT is a group of inherited peripheral neuropathies that affect motor and sensory function. Onion bulb formation is a characteristic feature of some subtypes of CMT, particularly those caused by mutations in the MPZ and PMP22 genes.

2. Chronic inflammatory demyelinating polyneuropathy (CIDP): 

CIDP is a chronic autoimmune disorder that affects the peripheral nerves, leading to weakness and sensory deficits. Onion bulb formation can be observed in some cases of CIDP, particularly those with a chronic and relapsing course.

3. Hypertrophic neuropathy: 

Hypertrophic neuropathy is a rare disorder that is characterized by the thickening of peripheral nerves and the presence of onion bulb formations.

The formation of onion bulbs is thought to result from the proliferation of Schwann cells in response to nerve injury or chronic inflammation. The excess Schwann cells then wrap around the axons of nerve fibers in a disorganized manner, leading to the formation of concentric layers of cells that resemble the layers of an onion. This abnormal proliferation and deposition of cells can lead to the compression and damage of nerve fibers, contributing to the neurological deficits observed in these conditions.

The presence of onion bulb formations in peripheral nerves is often used as a diagnostic feature for certain peripheral neuropathies, and can be visualized using techniques such as nerve biopsy or magnetic resonance imaging (MRI).