Brain injury: periventricular leukomalacia (PVL)

Periventricular leukomalacia (PVL) is damage and softening of the white matter within the brain near the cerebral ventricles.

• Periventricular means around or near ventricles, the spaces in the brain that make Cerebral Spinal Fluid (CSF).
• Leuko means white.
• Malacia means softening.

PVL and cerebral palsy

Like any damage to brain tissue, the exact location and depth of impairment will depend on how and where the body is affected. The areas around the ventricles near the basal ganglia and cerebellum contain nerves affecting movement. Babies with PVL may have a greater risk of developing cerebral palsy.

Causes of PVL

It's hard to establish the causes of PVL. This area of the brain can be prone to damage especially in premature or low birth weight babies where the tissue is fragile.

Possible causes can be:

• lack of oxygen
• ischemia (decreased blood flow)
• infection or rupturing of the uterus.

Hypotension (low blood pressure) resulting from foetal distress or caesarean birth can lead to decreased blood and oxygen supply to the developing brain and damage to the blood brain barrier which provides nutrients to the brain.

Diagnosis

As PVL may lead to a diagnosis of cerebral palsy, this may not be apparent until the child is older. The most common symptoms are:

• spastic diplegia (tight muscles in both limbs)
• contracted legs
• difficulties in positioning when sleeping or feeding

Severe PVL may be associated with quadriplegia. Children with PVL may have seizures. A study in Israel of 541 patients showed that 18.7% of those experienced seizures.

Seizures are more common in those born prematurely and with low birth weight. Infants with PVL often cannot maintain a steady gaze or co-ordinate eye movements. They may have spontaneous rapid eye movements (nystagmus) or a squint (strabismus).

Your medical practitioner may conduct a cranial ultrasound or MRI scan to detect any injury to brain tissue. The prognosis of patients with PVL depends on the severity and extent of white matter damage.

Treatments for PVL

There are no specific treatments for PVL. Treatments such as physiotherapy can ease specific effects.

Physiotherapy for CP