What happens in the brain during leukomalacia?
With leukomalacia of the brain, foci of necrosis appear in the subcortical structures, usually coagulative, nerve cells die, and the defects are replaced by multiplying microglial cells, similar to how scars form in other organs. Neurons cannot reproduce, and the brain has nothing to fill the dead fields with, so the result is cysts (cavities) - cystic leukomalacia.
More than half of cases of LP are accompanied by secondary hemorrhages in the area of ischemia and necrosis; hemorrhages into the ventricles of the brain are possible. It is important that the cerebral cortex in such children is affected extremely rarely due to good blood supply.
Leukomalacia begins in the first days and lasts about a week from the moment of birth. Its later occurrence is also possible, usually associated with infection or breathing problems in a newborn child. In these cases, against the background of existing necrosis, new ones may appear, and the child’s condition will progressively worsen.
Foci of multifocal leukomalacia with a diameter of 2-3 mm are found in the parietal and frontal lobes, symmetrically, around the walls of the lateral ventricles. Less commonly, the temporal and occipital lobes of the brain are affected. The outcome of necrosis is the formation of many cysts of different sizes, scattered throughout the subcortical layer of the brain (cystic degeneration), the number of which increases over time. In severe PL they occupy the entire periventricular part of the hemispheres.
It takes about two weeks for necrosis and the formation of cysts, and over the next few months, the cavities in the baby’s brain collapse, the dead areas are replaced with scars from neuroglia, and irreversible atrophy of the nervous tissue occurs.
leukomalacia on MRI images
