The predominance of grey matter injury is due to its high metabolic requirement for oxygen and glucose to supply a large number of synapses. This makes grey matter more susceptible to hypoxic-ischaemic injury 1. It also contains most of the dendrites where postsynaptic glutamate receptors are located. They are therefore the sites most susceptible to the effects of glutamate excitotoxicity (i.e., damage to nerve cells by excessive stimulation by glutamate).
Neurologic injury is caused by hypoxia (secondary to CO toxicity, near drowning, etc.) or interruption of blood flow (usually from cardiac arrest, or hanging). There is often secondary effects of hypoxia on cardiac myocytes, causing reduced cardiac output and causing further secondary neurological injury. Hypoxia alone rarely causes significant brain damage unless its profound and prolonged.
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