The frequent, though generally unrecognized, occurrence of damage to telencephalic white matter during the perinatal period prompted the present characterization of the pathological changes as well as a consideration of associated clinical and necropsy findings. Symmetrical astrocytosis or acutely damaged glial cells found predominantly in regions undergoing myelination suggest that the latter is associated with enhanced vulnerability. Although a single aetiological factor could not be identified in the clinical and necropsy data of the infants in this study, it may well be that the changes in developing white matter are non-specific morphological responses to a variety of noxious stimuli. The available data indicate an increasing deficit in brain weight with increasing survival age and the speculation is tendered that infants may survive the neonatal period with varying degrees of permanent symmetrical deficit of telencephalic white matter.
MATERIAL AND METHODSThe material consisted of 271 brains, ranging in age from six gestational months to the end of the third postnatal month, collected consecutively over a three year period, 1965 to 1967 inclusively. Sixty-six brains were set aside because of the presence of the following conditions: malformation or genetic abnormality, intracranial tumour, subdural haematoma, meningitis, hypoglycaemia embolic encephalopathy, phenylketonuria, rubella, hyperbilirubinaemia, and massive matrix haemorrhage with rupture into the telencephalon. Nine brains could not be utilized for technical reasons. The remaining 196 brains were obtained from patients dying from a variety of non-neurological diseases and constitute the basis of this report. Brains were fixed in one of three fixatives: 4% formaldehyde in physiological saline, phosphate buffered 4% formaldehyde, or 4% formaldehyde to which 2% calcium acetate and 2-5% sucrose had been added. The morphological abnormalities in these brains were not fixative dependent as adjacent blocks from both normal and abnormal brains fixed in each solution were comparable. All brains were cut in a standard fashion related to certain landmarks at the base of the brain. Representative blocks were processed and embedded in paraffin. Previous experience indicated that celloidin embedded material was not satisfactory for identifying glial abnormalities in unmyelinated or myelinating white matter. Sections were cut at 10 , and were stained with one or several standard stains or methods, including haematoxylin and eosin, phosphotungstic acid haematoxylin, Bodian for axons, Luxol Fast Blue, Solochrome Cyanin R, cresyl violet, Von Kossa, Gomori for iron, Millon's for protein, periodic acid Schiff, Gomori trichrome, and Holzer.The following morphological criteria of damage in myelinating white matter were utilized:HYPERTROPHIC ASTROCYTES Cells with pale vesicular nuclei and eosinophilic irregular hyaline cytoplasm (Figs. la and b) are not found in normal human myelinating telencephalic white matter (Mickel and Gilles, 1968). With appropriate stains they ...