Periventricular leukomalacia (PVL) is a specific type of injury to the brain which sometimes affects babies born prematurely. It is the most common birth-related brain injury that is caused by a lack of blood flow during labor and delivery.
PVL occurs when the white matter in the ventricles of the brain becomes damaged or decayed. White matter is very important because it facilitates electrical impulse signals that the brain uses to control the rest of the body. The cellular decay of the white matter tissue creates voids or holes within the brain. These holes eventually fill up with fluid which results in the condition known as PVL.
Periventricular leukomalacia (PVL) typically present when the baby is born but a formal diagnosis is normally not made until months later. Periventricular leukomalacia symptoms will often be different in each child, but the most common universal symptoms of PVL include:
• Abnormal developmental delays (failure to reach development milestones)
• Noticeably poor body control
• Spasticity, contractions, or tightness of the muscles (usually in the legs)
• Impaired vision and lack of eye control
Clinical seizures are also a common symptom of PVL in some babies with more severe injuries.
The cause of PVL is still uncertain, but medical researchers have surmised that lack of oxygen or lack of blood flow to the periventricular area of the brain is the primary reason the condition develops. Lack of oxygen and blood flow can occur when the infant isn’t delivered in time, such as when a physician fails to perform an emergency C-section.
Babies born too early are at risk as well; premature infants born before 32 weeks gestation are especially susceptible to PVL. Maternal infections and rupture of the amniotic sac are other causes that can lead to PVL.
Other causes can include –
• Using drugs while pregnant
• Failure of physicians to perform an emergency C-section
• Umbilical cord inflammation
• Antepartum hemorrhage
• Carrying twins
• Fetal membrane inflammation
• Infections in the womb during pregnancy
• Asphyxia during pregnancy, labor, and delivery
• Prolonged resuscitation of the infant
A cranial ultrasound is often the first diagnostic imaging tool used in diagnosing PVL. A cranial ultrasound is similar to a pregnancy ultrasound. It is performed on the newborn’s head and gives doctors images of the brain. The image results of a cranial ultrasound are analyzed to spot abnormalities associated with PVL.
A Computed Tomography (“CT”) scan and an MRI (Magnetic Resonance Imaging) are also used in the diagnosis of PVL.
There is currently no effective treatment for PVL. Once the damage occurs, the decayed white matter in the brain will never regenerate and cannot be repaired or restored. Although PVL is a permanent injury, careful monitoring and effective management of the condition can help limit its long term effects and symptoms.
Rehabilitative physical therapy and occupational therapy are typically utilized to help manage PVL. Medications can also be prescribed to address certain physical symptoms such as seizures.
PVL is not a progressive condition so its symptoms do not gradually worsen as the child gets older. The damage to the white matter occurs during brain development and does not continue to expand after birth.
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