Disorders of cerebral white matter are common, and their clinical sequelae have been found to range from the subtle to the catastrophic. The number of disorders affecting this subdivision of the brain is substantial, and more are likely to be added as new clinical, neuroradiologic, and neuropathologic information appears. Although elemental neurologic dysfunction has been well established and is important in the clinical manifestations of these disorders, a growing recognition of neurobehavioral dysfunction has emerged in recent years. Thus, the clinical impact of cerebral white matter disorders may be more significant than is currently appreciated.
Much work remains to be done on the etiology, pathogenesis, and treatment of these disorders. Given the wide variety of neuropathology that can occur, these tasks will require the contribution of neuroscien-tists and clinicians from many specialty areas. However, as a general rule, the prognosis for white matter disorders appears to be more favorable than that for gray matter diseases. In contrast to many disorders of gray matter that involve irrevocable destruction of neuronal cell bodies, there is frequent sparing of axons despite damage to myelin, and effective treatment seems more feasible. This therapeutic opportunity is another incentive to pursue the study of this group of disorders.
Finally, the cerebral white matter disorders offer a unique insight into brain function. The profound impairments that can attend lesions of white matter serve to illustrate that these tracts are essential components of distributed neural networks that subserve both elemental and higher cerebral functions. This principle is particularly well applied to the phenomena of cognition and emotion, in the operations of which the white matter plays an indispensible role. By considering the deficits that follow white matter lesions, an elegant view of the structure and function of the normal brain can be achieved. The prospects for continued advances in this area are bright, and these advances promise to assist both in the understanding of the human brain and in the alleviation of some its more tragic afflictions.
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