Periventricular Leukomalacia: Causes, Symptoms, Diagnosis, Treatment and Prevention

Damage to the white matter causes death and the breakdown of injured cells, called lateral ventricles, which fill with fluid.

It is a type of brain damage that involves the periventricular white matter of the brain.

The brain is composed mainly of white matter and gray matter. Gray matter has neuronal cell bodies, which can initiate nerve impulses, while white matter transports impulses between cells of gray matter.

The periventricular white matter that surrounds two horseshoe-shaped cavities in the brain is primarily responsible for the transmission of nerve impulses that control motor function. Damages in this area can cause spasticity and intellectual deterioration.

Myelin is an integral component of the white matter that instigates and isolates the cellular pathways, promoting rapid transmission of nerve impulses. The damage to the myelin slows down and prevents nerve transmission, possibly a strange brain function.

Approximately 60-100% of children with periventricular leukomalacia are diagnosed with Cerebral Palsy. Between 4 and 26% of premature babies who are placed in neonatal intensive care units have cerebral palsy.

In severe cases, postmortem examinations revealed that 75% of premature babies who died shortly after birth had periventricular leukomalacia.

Experts believe that intrauterine infections are the underlying factor of periventricular leukomalacia. The membranes surrounding the fetus are affected by the release of toxins, which are subject to some areas of the developing brain.

These toxins can also cause premature rupture of the membranes and premature birth.

When does periventricular leukomalacia occur?

Damage can occur at any time, but researchers have isolated stages of fetal development when the child is particularly vulnerable to periventricular leukomalacia. Although experts believe that the fetus is particularly vulnerable to periventricular leukomalacia between weeks 26 and 34 of gestation.

Preterm birth is a high risk factor for periventricular leukomalacia; It is more common in babies with 3.3 lbs.

What are the risk factors and causes of periventricular leukomalacia?

Experts report that blood flow or cellular damage to periventricular tissue is an underlying cause of periventricular leukomalacia. Babies born before 32 weeks of gestation and mechanically ventilated with a higher risk of periventricular leukomalacia.

The hypotension , hypoxemia, acidosis and hypocarbia in preterm infants ventilated can cause PVL. Several other events also raise a significant increase in the likelihood of developing periventricular leukomalacia.

Intrauterine infection, where abnormal bacteria can infect the amniotic fluid, is a factor; The infection at the time of delivery also increases the likelihood. This is more common during the premature delivery. Other risk factors associated with periventricular leukomalacia include:

  • Conditions of placental blood vessels, known as placental vascular anastomoses.
  • Twin gestation
  • Vaginal bleeding during pregnancy, known as antepartum hemorrhage.
  • Inflammation of the fetal membranes due to a bacterial infection, known as chorioamnionitis.
  • Inflammation of the connective tissue of the umbilical cord, known as funisitis.
  • Severe disease in which the bloodstream is overwhelmed by bacteria, known as sepsis.

What are the symptoms of periventricular leukomalacia?

Periventricular leukomalacia may be difficult to detect in newborns. Periventricular leukomalacia may resemble other conditions, and all cases are different.

Intellectual impairment, impaired development, visual dysfunction, hearing impairment and problem coordination are common with periventricular leukomalacia.

Spastic diplegia is the most common type of cerebral palsy caused by periventricular leukomalacia; Quadriplegia is the most severe.

How is periventricular leukomalacia diagnosed?

Cranial ultrasounds, magnetic resonance imaging, and computed tomography can identify periventricular leukomalacia.

Because early ultrasounds may not reveal periventricular leukomalacia, it is often possible to evaluate these conditions. Medical records and clinical tests can identify babies who will be tested.

How is periventricular leukomalacia treated?

Babies diagnosed with periventricular leukomalacia or at risk for periventricular leukomalacia require special care after hospital discharge. Cranial ultrasounds performed too early may not detect periventricular leukomalacia.

Frequent developmental evaluations are performed if periventricular leukomalacia is suspected. Treatment usually focuses on the management of symptoms through massage therapy, physiotherapy, speech therapy and the treatment of visual dysfunction.

How is periventricular leukomalacia prevented?

Intrauterine infection is difficult to detect, especially when there are no notable symptoms. Although some consider it impractical, it is suspected that others are more or less susceptible to periventricular leukomalacia.

Work is underway to develop an effective method of detection and treatment of pregnant women at risk of intrauterine infection.

Clarification of terminology

Because the terminology used is so specific, but remarkably similar, such brain defects, brain malformations, and brain injuries may seem confusing. It is useful to know the difference between trying to understand the cause of cerebral palsy.

Brain development begins shortly after conception. A relatively small number of cells divide and multiply into billions of cells. A small strip of tissue is wound up in a neural tube. One end develops in the brain and the other in the spinal cord.

At all times, different types of cells are formed, grouped and migrated to form various regions of the brain. The brain is considered fully developed two to five years after birth. Brain defects are irregularities in the structure of the brain that usually cause deterioration.

Defects can occur due to malformation, injury, illness or illness. The degree of deterioration is often related to the severity of the damage. Sometimes, a brain compensates for defects, in essence, by “reconnecting” to bypass or compensate for damaged areas. For this reason, as early as possible is typically recommended.

Brain malformations are abnormal and occur through the abnormal development of the brain. Although defects can occur during the course of development, the first week of life is more vulnerable; Any malformation that occurs while the neural tube is formed can have permanent consequences.

Brain malformations can result in undeveloped areas, abnormal growth, malformation, or inadequate brain division in hemispheres and lobes. Brain injuries are defects that occur due to injury or illness.

The causes of brain injuries during fetal development include bleeding in the brain, infections, toxins, suffocation and many others. Theories are usually the result of an incident or event that causes the death of brain tissue. The orifices, which are often filled with fluid, are left to form cysts.