Title:Cerebral White Matter Injuries Following a Hypoxic/Ischemic Insult During the Perinatal Period: Pathophysiology, Prognostic Factors, and Future Strategy of Treatment Approach. A Minireview
Volume: 21
Issue: 11
Author(s): Christian Zammit, Richard Muscat, Gabriele Sani, Cristoforo Pomara and Mario Valentino
Affiliation:
Keywords:
Perinatal ischaemia, periventricular leukomalacia, cellular mechanism, cerebral palsy, prognostic factors, treatment approach.
Abstract: Recent advances in medical care have significantly improved the survival rate of neonates who suffer a hypoxic/
ischemic event, before, during, or after birth. These infants are extremely vulnerable to brain injury and are at high
risk of developing motor and cognitive abnormalities later on in life. The regional distribution of perinatal brain injury
varies, and depends primarily on; the severity, pattern and type of insult, the metabolic status, and on the gestational age.
The principal neuropathological substrate that is affected in the premature infant is cerebral white matter. The aim of this
article is to re-examine the current knowledge on the ischemic pathophysiology of all cellular components that comprise the white matter,
pred ict the consequences of the long-term neurological outcome, and analyze possible therapeutic strategies. Although oligodendrocytes
have long been regarded as the hallmark of perinatal white matter injury, axons, astrocytes and microglia, all contribute to the complex
pattern of brain injury that occurs in this cohort of individuals. It is hoped that a better understanding of the pathophysiology of white
matter injury and its underlying prognostic factors, may lead to the development of new therapeutic strategies for such a complex and debilitating
condition.
