What is Periventricular Leukomalacia?

Periventricular Leukomalacia (PVL) is a widespread brain injury among premature newborns. It was described under different names, perhaps most notably as the “softening of the brain”. However, there is no softening of brain tissue in infants with PVL. Instead, the more appropriate description would be the “necrosis (cellular death) of white matter.” To better understand these terms, let’s discuss the science behind it.

The Anatomy of PVL

Deep inside the wrinkled gray matter found at the surface of the brain are the white matter. These are important in relaying impulses to other parts of the nervous system. These impulses that allow us to learn, move, and sense our surroundings. White matter makes a huge portion of the inside of the brain, including the area adjacent to two big chambers deeper inside, called the lateral ventricles. This specific area of white matter is the peri-ventricular area, which is the seat of motor control, among other things.

The Pathology of PVL

Among premature newborns, there is a slight possibility that the blood supply to the periventricular area is not yet developed at birth. If there is little to no blood supply to this area of the brain, the brain cells around it dies. And because the periventricular area takes care of the control of our movement, damage to this part of the brain can cause a spectrum of movement conditions.

The Causes of PVL

Several problems down the road can cause the actual death of periventricular brain cells. For instance, there could be predisposing factors that contribute to the likelihood of developing PVL. To name a few, this would include premature infants born before 32 weeks of gestation, very low birth weight less than 3.3 lbs., and gestational CMV infection.

Brought about by these predisposing factors, there are two likely causes of periventricular cell damage. First, there could be a decrease in oxygen supply to the area. Second, there could be a lesion in the blood supply towards the area.

The Incidence of PVL

PVL is highly common in premature newborns and infants born before their 32 weeks. Of these premature babies, 4-26% are likely to develop this condition. Such a number is frightening to think about, especially if 1 out of 4 premature babies is likely to have PVL.

The Presentation of PVL

Since the periventricular area is heavily in charge of the body’s motor control, damage to this area manifests as motor problems. In particular, there will be expected delays in the child’s motor development. As early as one month old, these problems can be detected. These motor delays can even manifest into actual disabilities, such as spastic cerebral palsy. They will have to carry these movement problems throughout their lives.

Aside from motor delays, a couple of visual problems can also take place. For example, these newborns will have a hard time controlling their eye movements as well. Maintaining a steady gaze on a stationary object would deem to be particularly difficult for them.

Moreover, neonates with PVL are very prone to have seizures. In an 8-yearlong study, it was found that 18.7% of PVL infants have had seizures. If left untreated, these seizures can become an actual epileptic condition. Worse, the epileptic shock itself can damage other nerve cells.

The Prognosis of PVL

As with other brain injuries like stroke, the prognosis of infants with PVL depends on the severity and location of the damage. Some can be relatively minor, while some can have permanent debilitating consequences, and even death.

In minor PVL cases, the infants would usually manifest with a cerebral palsy spastic diplegia. That means that their lower bodies are very stiff, and therefore, walking can be particularly hard. However, they can still do a lot with their upper bodies.

In more severe cases, all the limbs may be affected. That could result in a condition we call cerebral palsy spastic quadriplegia. As their movement becomes more limited, their participation in basic daily tasks is diminished.

The Diagnosis and Treatment for PVL

To verify and identify the extent of the PVL, there are usually state-of-the-art brain imaging tests. This imaging would range from a cranial ultrasound to an MRI scan. These imaging techniques are usually conducted until the child is at least six months old. This way, we can get a more accurate diagnosis.

Once the gravity of the condition is determined, the infant can then undergo a series of ophthalmological and therapy procedures. That would include neonatal ophthalmology, and physical, occupational, and speech therapy.

Speak with Trustworthy Birth Injury Lawyers about Your Situation

PVL is a birth injury to the brain whose causes are often natural, or away from human intervention. The best thing we can do for these infants with PVL is to give them all the possible treatment we can. This way, they can enjoy their lives despite their conditions.

If you have a reason to believe that there was negligence in handling your child’s birth that could have caused PVL, then it’s time to seek immediate legal advice from an expert birth injury attorney. Call The Clark Law Office at +1(517)347-6900 today. Together, let’s settle your birth injury case.

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