Cortical Laminar Pan Necrosis

A severe and prolonged hypoxic-ischemic insult affects not only the neurons but also the oligodendrocytes, the astrocytes, the myelin, and the axons, all of which undergo necrosis (infarction). This may occur in one or several laminae, or throughout the entire width of the cortex. The capillaries, least vulnerable to hypoxia, show prominent endothelial swelling and proliferation. Macrophages derived from microglial cells and blood monocytes gradually remove the tissue debris. Meanwhile, at the edge of the necrosis, the astrocytes proliferate into large gemistocytic astrocytes, separating the cortex from the healthy white matter. Ultimately, a loose mesoglial network replaces the cerebral cortex (see Figs. 3.4, 3.5, 3.7, and 3.8).

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