Periventricular leukomalacia (PVL) is a softening of white brain tissue near the ventricles. The ventricles are fluid-filled chambers in the brain. These are the spaces in the brain that contain the cerebrospinal fluid (CSF). The white matter is the inner part of the brain. It sends information between the nerve cells and the spinal cord, and from one part of the brain to another.
PVL occurs because brain tissue has
been injured or has died. A lack of blood flow to the brain tissue before, during, or
after birth causes PVL. It is rarely possible to tell when or why this happens. PVL is
sometimes linked to bleeding inside the brain (intraventricular hemorrhage). PVL can
occur in babies who are born early (preterm or premature).
With PVL, the area of damaged brain
tissue can affect the nerve cells that control motor movements. As the baby grows, the
damaged nerve cells cause the muscles to become tight or shaky (spastic) and hard to
move. Babies with PVL have a higher risk for cerebral palsy. This is a disorder that
causes problems with muscle control. A child with PVL may also have thinking or learning
It is not clear why PVL occurs.
This area of the brain is very vulnerable to injury, especially in preterm babies whose
brain tissues are more fragile. PVL may happen when the brain gets too little blood or
oxygen. But it is not clear when PVL occurs. It may occur before, during, or after
birth. Most babies who develop PVL are preterm, especially those born before 30 weeks.
Other things linked with PVL include early bursting or rupture of membranes (amniotic
sac) and infection in the uterus.
PVL can happen in any baby. But the risk is higher in babies who are born preterm. Smaller, younger preterm babies are at higher risk.
In some mild cases, the condition causes no symptoms. PVL may not be apparent until months after birth. Symptoms can occur a bit differently in each baby. The most common symptom of PVL is spastic diplegia. This is a form of cerebral palsy that causes tight, contracted muscles, especially in the legs.
The symptoms of PVL can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:
Cranial ultrasound. This is a
painless test that uses sound waves to make images of the tissues in the body. This
test is used to view the baby’s brain through the soft openings between the skull
bones (the fontanelles). In a baby with PVL, the ultrasound shows cysts or hollow
places in the brain tissue. Sometimes the condition can’t be seen with an ultrasound
right away. So healthcare providers give babies at risk for PVL an ultrasound 4 to 8
weeks after birth.
- MRI. This test uses large magnets, radio waves, and a computer to make images of the inside of the body. MRI may show some of the early changes in the brain tissue that occur with PVL.
There is no treatment to cure PVL. Babies at risk for PVL may need special care after discharge from the hospital. Follow-up may include physical therapy, occupational therapy, and speech therapy.
PVL may lead to problems with physical or mental development. The severity of these problems varies. In these cases, the baby still needs to be checked from time to time for signs of problems. In the most severe cases, PVL can cause cerebral palsy or other serious physical and mental delays. Only time can tell how severe a child’s disability will be.
If your child is diagnosed with PVL, he or she should be checked regularly by a developmental specialist. This can help detect problems early so you and your child can get help early.
Call the healthcare provider if your child has:
- Symptoms that don’t get better, or get worse
- New symptoms
- Periventricular leukomalacia (PVL) is a softening of white brain tissue near the ventricles. The white matter is the inner part of the brain. It sends information between the nerve cells and the spinal cord, and from one part of the brain to another.
- A lack of blood flow to the brain tissue before, during, or after birth causes PVL.
- PVL can happen in any baby. But the risk is higher in babies who are born preterm.
- Babies with PVL have a higher risk for cerebral palsy. A child with PVL may also have thinking or learning problems. In some mild cases, the condition causes no symptoms.
- There is no treatment to cure PVL. Babies at risk for PVL may need special care after discharge from the hospital. Follow-up may include physical therapy, occupational therapy, and speech therapy.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.