What are the other Names for this Condition? (Also known as/Synonyms)

• PVL (Periventricular Leukomalacia)
• White Matter Injury of Prematurity

What is Periventricular Leukomalacia? (Definition/Background Information)

• Periventricular Leukomalacia (PVL) is a type of brain damage that affects the white matter of the brain, predominantly in premature infants. The condition causes an interruption of the transportation of impulses from white matter to gray matter cells within the brain.
• The underlying cause of Periventricular Leukomalacia is suggested to be due to decreased blood flow and cell damage to the fetus. Commonly, low birth weight babies and premature infants are found to be affected by this condition
• The signs and symptoms of Periventricular Leukomalacia include an inability to control muscle movements that results in spastic, tight, resistant, and/or weak muscles. The disorder has been to shown to potentially increase the risk of cerebral palsy in infants, as well as induce developmental issues
• There is currently no effective means of treatment for Periventricular Leukomalacia for premature infants. Symptom management for PVL includes physical, massage, and speech therapies with treatment for visual dysfunction
• Periventricular Leukomalacia is very difficult to prevent due to the lack of noticeable symptoms during pregnancy. The prognosis of the condition depends on the amount of brain damage detected by cranial ultrasound and magnetic resonance imaging; the greater the damage, the poorer is the prognosis

Who gets Periventricular Leukomalacia? (Age and Sex Distribution)

• Periventricular Leukomalacia is a congenital condition that chiefly affects premature infants
• It can occur in both males and females
• PVL is observed across all racial and ethnic groups and is not limited by any geographic location

What are the Risk Factors for Periventricular Leukomalacia? (Predisposing Factors)

The risk factors that contribute to the development of Periventricular Leukomalacia include:

• Age: Studies have suggested that infants born prior to 32 weeks are at a higher risk
• Low birth weight is considered a risk factor, especially if the infant is below 3.3 pounds at birth
• Mechanical ventilation after birth increases the risk of developing Periventricular Leukomalacia
• Infants that present with hypotension, hypoxemia, and acidosis have an increased risk
• Infection: Maternal infection of the uterus, placental infection, or fetal infection can increase the risk of the condition
• Antepartum hemorrhage (vaginal bleeding during pregnancy) can increase the risk of having a child with Periventricular Leukomalacia
• Vascular anastomoses or placental blood vessel conditions affects the blood flow to the fetus increasing the risk for PVL
• The presence of inflammation, especially if located in the umbilical cord or fetal membranes, may increase the risk
• Substance abuse, namely the usage of cocaine by the expectant mother, drastically increases the risk of having a child with this brain disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Periventricular Leukomalacia? (Etiology)

The exact cause of development of Periventricular Leukomalacia is currently unknown.

• Nonetheless, research has suggested that cell damage or reduced blood flow and lack of oxygen to the periventricular region of the infant’s brain is a primary cause of Periventricular Leukomalacia
• The cause has also been attributed to myelin damage within the brain, which impedes nerve impulse transmissions
• Premature rupture of the amniotic sac during childbirth may be a potential cause
• Infection to the uterus during pregnancy may cause decreased blood supply to the developing fetus. This decreased blood supply to the developing fetal brain can result in PVL

What are the Signs and Symptoms of Periventricular Leukomalacia?

The signs and symptoms of Periventricular Leukomalacia may be difficult to detect. However, they may include:

• Visual dysfunction
• Hearing impairment
• Developmental impairment
• Lack of muscle coordination
• Intellectual impairment

It is important to note that symptoms present very differently in each child. Also, the symptoms may take some time to develop.

How is Periventricular Leukomalacia Diagnosed?

• Periventricular Leukomalacia can be diagnosed by a complete physical examination with a detailed medical history evaluation of the mother, including by studying the symptoms presented
• Upon a premature birth, examination can include cranial ultrasound and magnetic resonance imaging after the infant is over 6 months of age

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Periventricular Leukomalacia?

The complications of Periventricular Leukomalacia may include:

• Hemorrhage/bleeding in the periventricular region of the brain
• Abnormal development later on in life, due to the loss of brain tissue
• Mental or motor issues based on the severity of PVL presentation

How is Periventricular Leukomalacia Treated?

There is currently no specific treatment for Periventricular Leukomalacia. Upon diagnosis of Periventricular Leukomalacia, treatment plans depend on the severity of the symptoms.

• Therapy plans for managing the symptoms in infants may include:
  • Physical therapy
  • Massage therapy
  • Speech therapy
  • Treatment for visual dysfunction

How can Periventricular Leukomalacia be Prevented?

Periventricular Leukomalacia is a brain disorder that is very difficult to prevent due to the lack of noticeable symptoms during pregnancy.

• Preventing infection of the uterus, placenta, or the developing fetus decreases the risk
• Vaginal bleeding should be appropriately treated during pregnancy
• The expectant mother should completely avoid illicit medications and substance abuse
• Current (prenatal) tests, 5-7 seven months into an individual’s pregnancy, may be able to detect and treat infection. However, the efficacy of this prevention method is still questioned

What is the Prognosis for Periventricular Leukomalacia? (Outcomes/Resolutions)

• In general, the prognosis for Periventricular Leukomalacia can vary depending on the severity of the symptoms
• The prognosis is often linked to nervous system abnormalities and developmental issues that are especially prominent during the baby’s first and second years
• The prognosis of PVL is worsened if the developing child has severe signs and symptoms

Additional and Relevant Useful Information for Periventricular Leukomalacia:

Current research regarding Periventricular Leukomalacia by the US National Institute of Neurological Disorders and Stroke has shown promise with their clinical trials.