Marín-Padilla M
Department of Pathology, Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
J Neuropathol Exp Neurol. 1997 Mar;56(3):219-35. doi: 10.1097/00005072-199703000-00001.
The neuropathology and developmental impact of acute, subacute, and chronic white matter lesions has been studied in infants who survived (days, weeks, months, or years) this type of perinatal brain damage. The study emphasizes the survival of the developing gray matter overlying extensive white matter lesions (multicystic encephalopathy, porencephaly, and hydranencephaly ex-vacuo). Although partially isolated from afferent inputs (corticipetal fiber destruction) and unable to reach other cortical centers (corticofugal fiber destruction), this overlying gray matter is able to survive because neither its independent leptomeningeal blood supply nor its intrinsic anastomotic vasculature are affected by the underlying lesion. Moreover, the postinjury structural and functional development of this partially isolated gray matter is altered. Some of its axotomized pyramidal neurons are transformed into local-circuit interneurons, some of its interneurons are structurally and functionally enlarged (hypertrophy), and its intracortical neuropil (deprived of afferent synaptic terminals) increases by an expansion of intrinsic terminals (hypertrophy). An attempt has been made to correlate these postinjury alterations with the pathogenesis of the ensuing neurologic sequelae (7 infants develop epilepsy). The study proposes that neurological sequelae (e.g. epilepsy and cerebral palsy) following perinatal white matter lesions are a direct consequence of the postinjury gray matter transformations.
对于在围产期脑损伤后存活了不同时长（数天、数周、数月或数年）的婴儿，已经对急性、亚急性和慢性白质病变的神经病理学及发育影响进行了研究。该研究强调了在广泛白质病变（多囊性脑病、孔洞脑畸形和脑穿通畸形性积水性无脑畸形）之上发育中的灰质的存活情况。尽管该灰质部分地与传入输入（向心性纤维破坏）隔离，且无法到达其他皮质中枢（离心性纤维破坏），但由于其独立的软脑膜血供及其内在的吻合血管系统均未受到潜在病变的影响，所以能够存活。此外，这种部分隔离的灰质在损伤后的结构和功能发育发生了改变。其一些轴突切断的锥体神经元转变为局部回路中间神经元，一些中间神经元在结构和功能上增大（肥大），并且其皮质内神经毡（缺乏传入突触终末）通过内在终末的扩张（肥大）而增加。研究人员试图将这些损伤后的改变与随后神经后遗症（7名婴儿发生癫痫）的发病机制联系起来。该研究提出，围产期白质病变后的神经后遗症（如癫痫和脑瘫）是损伤后灰质转变的直接后果。
