Diffuse Fatty Change of White Matter

Abstract

The interpretation of diffuse fatty change of the white matter of newborns has been the subject of much controversy for more than a century, and the listing of this tissue alteration among the lesions of asphyctic and traumatic birth is open to challenge. Its description at this point of the text is merely a matter of concern for its overlap with the periventricular infarcts described in Chapter 4. Virchow (1867) described diffuse fatty change of the white matter of newborns under the title “Congenital Encephalitis and Myelitis”. He considered it the result of fatty metamorphosis of glia cells of the white matter of brain and of the tracts of spinal cord, with a general sparing of gray matter. His study was made during an epidemic of smallpox, and he attributed fatty change to an infective process transmitted from the mother to the infant. The interpretation of Virchow’s observations became embroiled in controversy from the very start, as other investigators noticed the near constant occurrence of fatty change in newborns. Hayem (1868) observed fatty change in all of 12 infants studied, but Virchow (1868, 1883) replied that it was often absent, particularly in stillborns and in infants who had not died upon birth.