Periventricular Leukomalacia Symptoms

Quick Answer

Periventricular leukomalacia (PVL) is a brain injury common in very premature and low birthweight babies. It causes injury to the brain’s white matter, which sends information between the spinal cord, the nerve cells, and different parts of the brain. Periventricular leukomalacia symptoms can range from mild to severe, with many cases developing into cerebral palsy and requiring lifelong care.

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What Is Periventricular Leukomalacia (PVL)?

A caregiver holds a premature newborn baby's tiny hand.

Periventricular leukomalacia (PVL) is a type of brain injury commonly found in premature babies. It involves the death of white matter near the brain’s ventricles (fluid-filled cavities). PVL often leads to spastic movement, vision problems, and developmental delays.

What Are the Symptoms of Periventricular Leukomalacia?

Periventricular leukomalacia symptoms generally appear as motor impairments and developmental delays in infants. These can include spastic cerebral palsy (CP), difficulties with coordination, and learning challenges.

However, it is important to understand that periventricular leukomalacia symptoms vary widely, so PVL can be difficult to diagnose and treat.

“Every child with PVL is unique and will have his or her own set of symptoms, which often become apparent over time as the child develops, rather than all at once.”

— Boston Children’s Hospital

With mild PVL symptoms, a baby may not show any signs of periventricular leukomalacia at birth. However, developmental delays and motor function problems, which typically worsen with time, may appear soon after.

These periventricular leukomalacia symptoms may appear as a child grows:
  • Coordination and movement issues
  • Developmental delays
  • Learning disabilities
  • Motor delay and impairments
  • Seizures
  • Visual impairments

If you have questions about periventricular leukomalacia symptoms, our registered nurses can help. With decades of combined experience in labor and delivery, our nurses are here to listen to your story and answer your questions.

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Early Symptoms of Periventricular Leukomalacia

Early periventricular leukomalacia symptoms appear by six to nine months of age.

The most common symptoms of early-stage PVL include the following.

Vision and Eye Movement Troubles

Babies with PVL often have eye movement and vision troubles, including:

  • Crowding is when objects that can be recognized when viewed in isolation aren’t recognizable in clutter.
  • Nystagmus is a vision condition where the eyes make uncontrolled, repetitive movements. It can cause reduced depth and vision perception and affect balance and coordination.
  • Strabismus is when both eyes don’t look at the same place at the same time.

Muscle Stiffness and Movement Issues

PVL can hurt the nerve pathways that control motor movements, resulting in muscles that are weak and resistant to movement (spasticity). Infants with PVL have a higher risk of developing cerebral palsy.

Developmental Delays

Babies with PVL have difficulty reaching developmental milestones. Their cognitive delays will become more obvious with time.

Later Symptoms of Periventricular Leukomalacia

As children with PVL grow older, periventricular leukomalacia symptoms become more prominent.

Symptoms of late-stage PVL include the following.

Exaggerated Leg Reflexes

Stiff muscles can cause exaggerated leg reflexes, making movements difficult for children with PVL.

Walking Issues

Periventricular leukomalacia symptoms as a child develops may involve weakness in one or both legs. This can make walking difficult. Children with PVL may need wheelchairs, canes, walkers, and other adaptive equipment.

Fatigue

Children with PVL are more likely to be fatigued (extremely tired) due to their muscles contracting and tightening.

Other Effects on Muscles, Bones, Joints, and Ligaments

As children with PVL get older, periventricular leukomalacia symptoms can develop into physical problems. These may progress from the legs to other areas of the body due to the fatigue caused by contracted and tightened muscles.

A challenge of detecting periventricular leukomalacia symptoms is that they are not always obvious until a baby starts missing milestones.

If you have any concerns, take our free milestone quiz now to see if your baby is on track.

IS YOUR CHILD MISSING DEVELOPMENTAL MILESTONES?

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Taking note of your child’s physical, social, and emotional skills can help you determine if they potentially suffered from an injury at birth. An early diagnosis can help your child get the treatment they need as soon as possible.

Q1: How old is your child?

0-2 Months

3-4 Months

5-6 Months

7-9 Months

10-12 Months

13-18 Months

19-23 Months

24+ Months

0-2 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child hold their head steadily on their own?
  • Q3: Can your child push themselves up when they are lying on their stomach?
  • Q4: Has your child started to make smoother movements with their arms and legs?
  • Q5: Does your child smile at other people?
  • Q6: Can your child bring their hands to their mouth?
  • Q7: Does your child turn their head when they hear a noise?
  • Q8: Does your child coo or make gurgling noises?
  • Q9: Does your child follow things with their eyes?
  • Q10: Does your child try to look at their parents or caregivers?
  • Q11: Does your child show boredom, cry, or fuss when engaged in an activity that hasn’t changed in a while?
0-2-years old child

3-4 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child hold their head steadily on their own?
  • Q3: Does your child push down on their legs when their feet are on a flat surface?
  • Q4: Has your child started to roll over from their stomach to their back?
  • Q5: Can your child hold and shake a toy such as a rattle?
  • Q6: Does your child bring their hands to their mouth?
  • Q7: Does your child play with people and start to cry when the playing stops?
  • Q8: Does your child smile spontaneously, especially at people?
  • Q9: Does your child copy some movements and facial expressions of other people?
  • Q10: Does your child babble with expressions and copy sounds they hear?
  • Q11: Does your child cry in different ways to show hunger, pain, or tiredness?
  • Q12: Does your child respond to affection like hugging or kissing?
  • Q13: Does your child follow moving things with their eyes from side to side?
  • Q14: Does your child recognize familiar people at a distance?
3-4-years old child

5-6 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child roll over on both sides (front to back/back to front)?
  • Q3: Has your child begun to sit without support?
  • Q4: Does your child rock back and forth?
  • Q5: Can your child support their weight on their legs (and perhaps bounce) when standing?
  • Q6: Has your child begun to pass things from one hand to the other?
  • Q7: Does your child bring objects such as toys to their mouth?
  • Q8: Does your child know if someone is not familiar to them and is a stranger?
  • Q9: Does your child respond to other people’s emotions, such as a smile or a frown?
  • Q10: Does your child enjoy looking at themselves in the mirror?
  • Q11: Does your child look at things around them?
  • Q12: Does your child respond to sounds they hear by making sounds themselves?
  • Q13: Does your child make sounds to show joy or displeasure?
  • Q14: Does your child respond to their own name?
  • Q15: Has your child started to string vowels together, such as "ah," "eh," or "oh," or started to say consonant sounds such as "m" or "b"?
  • Q16: Has your child begun to laugh?
5-6-years old child

7-9 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child crawl?
  • Q3: Can your child stand while holding on to something to support them?
  • Q4: Can your child sit without support?
  • Q5: Can your child pull themselves up to stand?
  • Q6: Does your child play peekaboo?
  • Q7: Can your child move things from one hand to the other?
  • Q8: Can your child pick small things up, such as a piece of cereal, with their thumb and index finger?
  • Q9: Does your child look for things that they see you hide?
  • Q10: Does your child watch the path of something as it falls?
  • Q11: Does your child show fear when around strangers?
  • Q12: Does your child become clingy with adults who are familiar to them?
  • Q13: Does your child have favorite toys?
  • Q14: Does your child use their fingers to point?
  • Q15: Does your child understand “no”?
  • Q16: Does your child make a lot of repetitive sounds, such as “mamama” or “bababa”?
  • Q17: Does your child copy the sounds and gestures of other people?
7-9 years old child

10-12 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child stand alone with no support?
  • Q3: Does your child walk while holding on to furniture?
  • Q4: Can your child take a few steps without holding on to anything?
  • Q5: Can your child get into a sitting position without any help?
  • Q6: Does your child bang two things together when playing?
  • Q7: Does your child poke with their index finger?
  • Q8: Has your child started to use things like hairbrushes or drinking cups correctly?
  • Q9: Does your child find hidden objects easily?
  • Q10: Does your child play peekaboo or pat-a-cake?
  • Q11: Does your child become shy or nervous around strangers?
  • Q12: Does your child repeat actions or sounds to get attention?
  • Q13: Does your child put out an arm or leg to help when getting dressed?
  • Q14: Does your child cry when a parent leaves the room?
  • Q15: Does your child show that they have favorite things or people?
  • Q16: Does your child show fear?
  • Q17: Does your child say things such as “mama,” “dada,” or “uh-oh”?
  • Q18: Does your child try to say the words you say?
  • Q19: Has your child started to use gestures like waving or shaking their head “no”?
10-12 years old child

13-18 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child walk by themselves?
  • Q3: Does your child walk up stairs and run?
  • Q4: Does your child pull toys while walking?
  • Q5: Can your child drink from a cup on their own?
  • Q6: Can your child eat with a spoon on their own?
  • Q7: Can your child help undress themselves?
  • Q8: Does your child have occasional temper tantrums?
  • Q9: Does your child show affection to familiar people?
  • Q10: Does your child become clingy in new situations?
  • Q11: Does your child explore their environment alone with parents close by?
  • Q12: Can your child say several single words?
  • Q13: Can your child say and shake their head “no”?
  • Q14: Does your child point to show things to other people?
  • Q15: Does your child scribble?
  • Q16: Does your child know what ordinary products such as phones, spoons, and brushes are used for?
  • Q17: Can your child follow one-step commands such as “sit down” or “stand up”?
  • Q18: Does your child play with a doll or stuffed animal by pretending to feed it?
13-18 years old child

19-23 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Has your child begun to run?
  • Q3: Has your child kicked a ball?
  • Q4: Can your child climb down and onto furniture on their own?
  • Q5: Can your child walk up and down stairs while holding on?
  • Q6: Can your child stand on their tiptoes?
  • Q7: Has your child thrown a ball overhand?
  • Q8: Does your child copy others, especially people older than them?
  • Q9: Does your child get excited around other children?
  • Q10: Has your child shown more independence as they've aged?
  • Q11: Does your child do what they were told not to do and become defiant?
  • Q12: Does your child point to things when they are named?
  • Q13: Does your child know names of familiar people or body parts?
  • Q14: Does your child say 2 to 4-word sentences?
  • Q15: Does your child repeat words they hear?
  • Q16: Does your child complete sentences and rhymes in familiar books?
  • Q17: Does your child name items in books, such as dogs, cats, and birds?
  • Q18: Does your child play simple pretend games?
  • Q19: Has your child started to use one hand more than the other?
  • Q20: Has your child begun to sort shapes and colors?
  • Q21: Does your child follow 2-step instructions, such as “pick up your hat and put it on your head?”
19-23 years old child

24+ MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child run easily?
  • Q3: Can your child climb?
  • Q4: Can your child walk up and down stairs with one foot on each step?
  • Q5: Can your child dress and undress themselves?
  • Q6: Does your child show affection for friends without being told?
  • Q7: Does your child take turns when playing games?
  • Q8: Does your child show concern when others are crying?
  • Q9: Does your child understand the idea of “mine" and "theirs"?
  • Q10: Does your child show many different emotions?
  • Q11: Does your child copy adults and friends?
  • Q12: Does your child separate easily from their parents?
  • Q13: Does your child get upset when there is a major change in their routine?
  • Q14: Does your child say words such as “I,” “me,” “we,” “you,” and some plural nouns?
  • Q15: Can your child say their first name, age, and gender?
  • Q16: Can your child carry on a conversation with 2 to 3 sentences?
  • Q17: Can your child work toys with buttons and other moving parts?
  • Q18: Does your child play pretend with dolls, animals, or people?
  • Q19: Can your child finish 3 or 4 piece puzzles?
  • Q20: Can your child copy a circle when drawing?
  • Q21: Can your child turn pages of a book one page at a time?
  • Q22: Can your child turn door handles?
24 months + old child

Causes & Risk Factors for Periventricular Leukomalacia

Periventricular leukomalacia causes are not always known, but medical experts believe PVL could be caused by a lack of blood flow to the periventricular part of the brain.

The periventricular area is around the ventricles (fluid-filled spaces in the brain), where nerve fibers transmit messages from the brain to the body.

Risk factors of PVL include:
  • Early breaking of the amniotic sac (fluid-filled membranes that hold a baby in the uterus)
  • Infant brain bleed (intraventricular hemorrhage)
  • Lack of oxygen or blood to your child’s brain
  • Low infant birth weight
  • Uterine infection
  • Water breaking early

Medical Malpractice & Periventricular Leukomalacia

In some cases, PVL is caused by medical negligence by delivery teams. Health care professionals are trained to prevent conditions like oxygen deprivation or infections during childbirth that can cause PVL.

If your child’s PVL could have been avoided, it could mean birth injury medical malpractice was involved, and your family may have legal rights.

When medical negligence causes a life of challenges and financial burdens, families should not be left to face it alone. While taking legal action may sound intimidating, with the help of an experienced birth injury attorney, the process is simplified and stress-free.

See if you are eligible to seek the compensation you need to care for your child with a free case review right now.

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What to Do If You See Periventricular Leukomalacia Symptoms

If you suspect periventricular leukomalacia symptoms in your child, especially during the first few months after delivery, here are some steps you can follow.

Most importantly, talk with your child’s doctor or seek emergency medical treatment if you have immediate concerns.

1. Request a Physical Exam

A physical exam checks your child’s overall health and can help in detecting periventricular leukomalacia symptoms. Your child’s pediatrician can evaluate the basic function of your child’s organs and order additional tests as needed.

2. Seek Further Testing

After performing a physical exam, your child’s doctor may suggest other tests, including:

  • Magnetic resonance imaging (MRI) exam uses radio waves, a computer, and magnets to take images inside your child’s body. MRIs can show changes in your child’s brain tissue.
  • Ultrasound uses sound waves to take pictures of body tissues. If your child has PVL, the ultrasound will show hollow places or cysts in their brain tissue. Medical providers usually do a head or cranial ultrasound four to six weeks after delivery.

3. Learn About the PVL Diagnosis

If your child has PVL, the doctor will tell you everything you need to know about the condition. They may refer you to different specialists, including pediatric neurologists.

4. Seek a Second Opinion

To ensure your child gets an accurate diagnosis, seek a second opinion from another doctor.

Periventricular leukomalacia symptoms can be mistaken for:
  • Diffuse white matter gliosis (DWMG) is the mildest form of cerebral white matter injury. It can cause issues with mobility, memory, and balance.
  • Periventricular venous infarction (PVI) is a common fetal stroke that may only cause motor deficits.

5. Create a PVL Care Plan

If your child is diagnosed with PVL, creating a lifelong care plan is recommended. While there is no treatment for PVL, you should be prepared to manage any symptoms your child develops.

Treatments depend on the severity and degree of periventricular leukomalacia symptoms, such as your child’s ability to move and feed themselves, cognitive (mental) abilities, and breathing functioning.

Your child’s doctor can help you create a suitable treatment plan for your child.

Can Periventricular Leukomalacia Cause Long-Term Damage?

Yes, periventricular leukomalacia symptoms can mean underlying conditions that will cause long-term damage. This could include cerebral palsy.

The most common PVL-induced type of CP is spastic diplegia, characterized by contracted, tight muscles, especially in the legs. The prognosis for cerebral palsy varies, but it is possible that your child will need lifelong care.

The potential for lasting damage is why it’s so important to recognize periventricular leukomalacia symptoms early and seek treatment as soon as possible.

Find Help for a Periventricular Leukomalacia Birth Injury

If you suspect your child is showing periventricular leukomalacia symptoms, don’t wait to explore your options. When preventable PVL occurs, seeking justice and financial compensation through a birth injury lawsuit may be the best path forward for your family.

The Birth Injury Justice Center partners with top birth injury law firms across the country. Together, our legal partners have helped recover $917 million for families affected by preventable birth injuries. Find out if they can help yours.

Call (800) 914-1562 24/7 or fill out our free case review form now.

Periventricular Leukomalacia Symptoms FAQs

What are the stages of periventricular leukomalacia?

There are four stages of periventricular leukomalacia (PVL):

  1. Congestion or echogenicity (dense lesions of periventricular white matter)
  2. Relative normalization
  3. Development of cysts
  4. Resolution of cysts but development of ventricular enlargement

Is periventricular leukomalacia brain damage?

Yes, PVL is a type of injury to the baby’s brain. It is most common in very premature babies. It can cause cerebral palsy, learning difficulties, and vision problems.

Can PVL go away on its own?

No, PVL doesn’t go away on its own. The brain damage associated with PVL can’t be reversed.

Talk to your doctor to see how severe your baby’s PVL is and what kind of treatment options they should receive. Children with PVL may benefit from physical therapy, speech therapy, and occupational therapy.

Can a baby with PVL live a normal life?

Yes. PVL can be mild, moderate, or severe, and many people with mild PVL live active lives with only a few health problems.

On the other hand, people with severe PVL may have permanent disabilities.

Birth Injury Support Team
Reviewed by:Beth Carter, RN

Registered Nurse, Legal Nurse Consultant Certified

  • Fact-Checked
  • Editor

Beth Carter has over 18 years of experience as a Registered Nurse. She spent nearly half of that time working in labor and delivery units. This, combined with her own experience giving birth to a premature baby, ignite Beth’s passion for helping new mothers access the information and resources they deserve.

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 Sources
  1. Boston Children’s Hospital. (2012). Periventricular leukomalacia. Retrieved August 17, 2023, from https://www.childrenshospital.org/conditions/periventricular-leukomalacia
  2. Cedars Sinai. (n.d.) Periventricular leukomalacia (PVL) in children. Retrieved August 17, 2023, from https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/p/periventricular-leukomalacia-pvl-in-children.html
  3. Children’s Hospital of Philadelphia. (n.d.) Periventricular leukomalacia (PVL). Retrieved August 17, 2023, from https://www.chop.edu/conditions-diseases/periventricular-leukomalacia-pvl
  4. Cleveland Clinic. (2022, February 17). Periventricular leukomalacia (PVL). Retrieved August 17, 2023, from https://my.clevelandclinic.org/health/diseases/22397-periventricular-leukomalacia-pvl
  5. Cleveland Clinic. (2022, May 4). White matter disease. Retrieved August 17, 2023, from https://my.clevelandclinic.org/health/diseases/23018-white-matter-disease
  6. National Institute of Neurological Disorders and Stroke. (2023, January 20). Periventricular leukomalacia. Retrieved August 17, 2023, from https://www.ninds.nih.gov/health-information/disorders/periventricular-leukomalacia

 

Nurse Beth Carter

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