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Infant subcortical cystic leucomalacia: a distinct pathological entity resulting from impaired fluid handling
Waney Squier1, Topun Austin, Philip Anslow
1Department of Neuropathology, John Radcliffe Hospital, Oxford, United Kingdom. waney.squier@clneuro.ox.ac.uk
Insights
Subcortical cystic leucomalacia in infants results from fluid accumulation, not tissue necrosis. This age-related condition in the white matter may stem from immature fluid handling pathways following hypoxic-ischaemic injury.
Area of Science:
- Neonatal neurology
- Pediatric pathology
- Neurodevelopmental disorders
Background:
- Infants' subcortical white matter is susceptible to fluid accumulation and cystic changes in early life.
- This condition is often attributed to hypoxic-ischaemic injury (HII) and grouped with periventricular leucomalacia (PVL).
Purpose of the Study:
- To detail the sequential tissue changes in infant subcortical cystic leucomalacia.
- To differentiate this condition from other white matter diseases to understand its pathogenesis and etiology.
Main Methods:
- Examined frontal lobe tissue samples from infants who died after global HII.
- Correlated pathological changes with survival times (2 hours to 13 days) post-collapse.
Main Results:
- Subcortical white matter showed increasing edema with survival time after HII.
- Cysts appeared by day one, peaking after five days, and resulted from fluid accumulation, distinct from PVL's necrosis.
- No cellular responses were associated with cyst formation.
Conclusions:
- Subcortical leucomalacia arises from fluid accumulation, not tissue necrosis.
- Age-related predisposition may involve immature fluid handling pathways.
- Pathogenesis and etiology warrant further investigation.
Background:
In the first months of life the subcortical white matter appears prone to fluid accumulation and cystic change. This condition has generally been considered to be due to hypoxic-ischaemic injury (HII) and is grouped with other forms of white matter disease including periventricular leucomalacia (PVL).
Aims:
Our aim was to describe the sequential tissue changes in the formation of subcortical cystic leucomalacia in the infant brain and to delineate this from other forms of white matter disease in order to better understand its pathogenesis and aetiology.
Study Design:
Standard samples of the frontal lobe, including subcortical white matter, were stained to demonstrate the cellular processes responsible for subcortical cyst formation in infants who had died from global hypoxic-ischaemic injury (HII) and brain swelling. Cases were of infants who had survived for known periods after collapse in order to determine the time course of the pathological changes.
Subjects:
20 infants under 5 months of age with global HII and no other primary brain pathology, and who had survived for between 2h and 13 days after collapse.
Outcome Measures:
The description of the sequential changes leading to subcortical cyst formation in infants after severe global HII.
Results:
With increasing time of survival after global HII the subcortical white matter became more oedematous. Subcortical cysts were seen after one day but were most common in infants surviving more than 5 days. Cysts were not associated with cellular responses and seemed to be the result of fluid accumulation. The pathology was quite distinct from PVL which is due to tissue necrosis.
Conclusions:
Subcortical leucomalacia results from fluid accumulation and not necrosis. Predisposition to fluid accumulation may be age-related and due to impairment of fluid handling pathways which remain immature in this age group. Potential mechanisms are discussed.
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