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Periventricular leukomalacia

Periventricular leukomalacia (PVL) is a type of brain injury that affects infants. The condition involves the death of small areas of brain tissue around fluid-filled areas called ventricles. The damage creates "holes" in the brain. "Leuko" refers to the brain's white matter and "periventricular" refers to the area around the ventricles.

Alternative Names

PVL; Brain injury - infants

Causes, incidence, and risk factors

PVL is much more common in premature infants than in full-term infants.

A major cause is thought to be changes in blood flow to the area around the ventricles of the brain. This area is fragile and prone to injury, especially before 32 weeks of gestation.

Infection around the time of delivery may also play a role in causing PVL. The more premature your baby is and the sicker your baby is, the higher the risk for PVL.

Premature babies who have intraventricular hemorrhage (IVH) are also at increased risk for developing this condition.

Signs and tests

Tests used to diagnose PVL include ultrasound and MRI of the head.

Treatment

There is no treatment for PVL. The baby's heart, lung, intestine, and kidney functions will be monitored and treated so they remain as normal as possible.

Expectations (prognosis)

PVL often leads to nervous system and developmental problems in growing babies, usually during the first to second year of life. It may cause cerebral palsy (CP), especially tightness, or increased muscle tone (spasticity) in the legs.

Babies with PVL are at risk for major nervous system problems, especially involving movements such as sitting, crawling, walking, and moving the arms. These babies may need physical therapy.

A baby who is diagnosed with PVL should be monitored by a developmental pediatrician or a pediatric neurologist, in addition to the child's regular pediatrician.

References

Volpe JJ. Neurology of the Newborn. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2008; chap 8.

Updated: 11/14/2011

Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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