Periventricular Leukomalacia (PVL)

Quick Answer

Periventricular leukomalacia (PVL) may occur when the white matter in a baby’s brain is damaged. White matter is responsible for motor function, so PVL can lead to spastic movements, vision problems, and other health issues. In some cases, PVL is preventable.

What Is Periventricular Leukomalacia?

Periventricular leukomalacia (PVL) is a form of brain damage that can occur before or shortly following birth. It specifically affects the periventricular white matter, which is a type of subcortical brain tissue (found below the brain’s surface). This tissue contains and protects axons, or nerve fibers, which are extensions of neurons (nerve cells).

Also present within white brain tissue are fluid-filled chambers or ventricles that hold cerebrospinal fluid (CSF). This clear fluid acts as a shock absorber, protecting the brain and spinal cord against impacts and jolts.

White matter is responsible for generating nerve impulses that allow for motor functioning, such as voluntary movement. If this tissue becomes damaged and a baby develops PVL, they may experience spastic movement, vision problems, and cognitive or learning impairments associated with cerebral palsy.

When Does Periventricular Leukomalacia Occur?

PVL commonly occurs in the third trimester, but it can also happen during premature deliveries.

Lower-than-average birth weights and early deliveries are generally more likely to cause brain injury, meaning preterm or premature babies are more at risk of developing PVL.

There is also an increased risk of PVL for premature infants who suffer an intraventricular hemorrhage (IVH) or bleeding within the brain.

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What Causes Periventricular Leukomalacia?

PVL is usually caused by brain tissue that has been injured or has died due to a lack of blood flow. Although the exact reasons this happens are not known, it may be associated with IVH that occurs before, during, or after birth.

Other risk factors for PVL-related brain tissue injury include:

  • Hypoxia-ischemia

    This results in brain dysfunction when blood flow to the brain is limited or when the brain experiences a lack of oxygen for some time.

  • Infection

    Another PVL cause is neonatal infection, which can cause a fetal inflammatory response. Newly born infants are typically at high risk for infections at the time of delivery.

  • Low birth weights

    The area of the brain that, when damaged, causes PVL is very fragile and can be prone to injury or infection. This is especially true when a baby is born prematurely or has a lower-than-average birth weight.

Periventricular Leukomalacia Symptoms

Children with mild periventricular leukomalacia may display no symptoms except some delays in early developmental phases. That said, PVL usually reveals itself differently in each newborn or young child.

The most common symptom of moderate to severe PVL is a form of cerebral palsy known as spastic diplegia, which is characterized by stiff and jerky movements.

Did you know

Often, the symptoms of PVL are not evident until months after the child has been born.

The child’s underlying brain damage will cause tight and contracted muscle movement in the lower limbs. As an infant, the child may show exaggerated reflexes in the legs. As the child learns to walk, a noticeable scissor-like gait or walking on tiptoes can be typical.

PVL symptoms may also look like other health conditions in which the leg muscles stiffen. As children grow older, however, those symptoms may display in different ways or progress into other areas due to the fatigue caused by the uncontrolled muscle movements and spasticity.

Bones, muscles, joints, and ligaments are all affected by the ongoing spastic movements and make it difficult to predict how well the child will eventually perform in specific skills such as walking or running.

How Is PVL Diagnosed?

When a parent or medical professional notices signs of PVL, the first diagnostic step is reviewing the child’s medical history and performing a physical exam to verify the reported symptoms.

If the physical examination warrants the need for further testing, certain diagnostic procedures will be used to collect brain and spinal cord tissue images.

Periventricular leukomalacia diagnostic tests include magnetic resonance imaging (MRI) and cranial ultrasounds. An MRI uses medical equipment containing magnets, radio waves, and computer software to take photos of the inside of the brain.

To help diagnose PVL, doctors use MRIs to look for signs of brain tissue damage. An MRI can also be used to detect the severity of brain damage, bruising or scarring on the brain, and minute bleeding (microhemorrhage).

A cranial ultrasound uses sound waves that reflect images of the brain’s surface and interior chambers (ventricles).

Several weeks after birth and before the bones of a child’s skull have grown together, a cranial ultrasound test is used to visualize the flow of CSF. It can detect problems such as bleeding in the brain, infections, or brain tissue damage.

These tests will not only be used for PVL diagnosis but also to project the long-term outlook for a child. The severity of PVL symptoms can vary widely, leaving some children with mild developmental delays and others with severe movement and cognitive issues.

Periventricular Leukomalacia Prognosis

A PVL prognosis is the condition’s predicted outcome that may include evaluating the child’s future likelihood to execute specific skills as they grow older. Similar to many other birth injuries, the prognosis of PVL can vary widely child to child.

In some cases, a developmental specialist can help pinpoint early motor skill problems or learning difficulties to recommend the right treatments. That said, children with PVL often remain in a static condition, where the root symptoms do not worsen or improve.

Did you know

Depending on the severity of the PVL diagnosis, some children may require ongoing personal assistance to perform daily activities.

With milder cases of PVL, most children grow to lead semi-independent or self-sufficient adult lives. As the patient gets older, the changing nature of the body and mind may increase the need for assistance in the middle to late years.

Monitoring PVL symptoms throughout the patient’s life is the best way to treat and predict treatment outcomes. With the right treatments and therapies, most patients can expect an improvement in quality of life and an increased life expectancy.

What Are the Treatment Options for PVL?

There is no treatment to cure the primary disease of PVL, but the secondary symptoms can be managed with special care for infants immediately after hospital discharge.

As the baby develops through early childhood, speech therapy and physical therapy may be needed.

Additionally, occupational therapy can help young children develop gross motor skills like standing, walking, and running, as well as fine motor skills that require dexterity and hand-eye coordination.

The primary goals of long-term PVL treatment are to improve mobility, maximize independence, and increase social interactions.

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Preventing Periventricular Leukomalacia

Children with PVL have a higher risk of developing cerebral palsy and, for this reason, medical professionals take certain precautions to reduce the risk of PVL in pre- and full-term infants.

PVL prevention methods include:

  • Reducing the risk of prematurity
  • Preventing lack of oxygen/blood flow to the baby’s brain
  • Reducing blood pressure swings and hypotension

Additionally, cooling of the head and/or body through therapeutic hypothermia has been shown to help prevent disabilities and developmental delays in some cases.

“Premature babies’ heart, lung, intestine, and kidney functions are watched closely and treated in the newborn intensive care unit (NICU). This helps reduce the risk of developing PVL.”

– U.S. National Library of Medicine

Expectant mothers may be able to help reduce the risk of periventricular leukomalacia and other birth injuries by minimizing their risk of infection, avoiding use of drugs and alcohol, and ensuring they are being monitored by their doctors for major health issues.

Compensation for Preventable Periventricular Leukomalacia

Periventricular leukomalacia can leave your newborn disabled for the rest of their life. Fortunately, compensation may be available to ease some of the burdens.

Financial compensation can help you pay for:

  • Medications, surgery, and other treatments that can help your child
  • Adaptive equipment like wheelchairs and crutches
  • Physical therapy to help with muscle spasticity
  • Other expenses that stem from your child’s condition

You can pursue compensation from the doctors who helped deliver your child. These doctors were trained to properly prevent PVL in high-risk babies. If they didn’t, your child’s lifelong impairments may be their fault.

To learn more about accessing compensation for PVL and other birth injuries, get a free case review.

Birth Injury Support Team

The Birth Injury Justice Center was founded in 2003 by a team of legal professionals to educate and empower victims and families affected by birth injuries. Our team is devoted to providing you with the best resources and legal information for all types of birth injuries.

View 4 Sources
  1. Cedars Sinai. (n.d.). Periventricular Leukomalacia (PVL) in Children. Retrieved November 05, 2020, from https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/p/periventricular-leukomalacia-pvl-in-children.html
  2. U.S. National Library of Medicine. (n.d.). Periventricular leukomalacia: MedlinePlus Medical Encyclopedia. Retrieved November 05, 2020, from https://medlineplus.gov/ency/article/007232.htm
  3. UR Golisano Children's Hospital. (n.d.). Periventricular Leukomalacia. Retrieved November 05, 2020, from https://www.urmc.rochester.edu/childrens-hospital/developmental-disabilities/conditions/periventricular-leukomalacia.aspx
  4. Zaghloul, N., & Ahmed, M. (2017, November). Pathophysiology of periventricular leukomalacia: What we learned from animal models. Retrieved November 05, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745826/
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