Periventricular Leukomalacia

Nationwide Cerebral Palsy Resource Network

An injury that involves the white matter of the brain and results in fluid filled lateral ventricles and unstable transmission of nerve impulses, periventricular leukomalacia (“PVL”) most often affect fetuses and premature infants, particularly those born prior to 32 weeks gestation and having a birth weight below 3.3 lbs. It is estimated that 60 to 100 percent of infants born with PVL will be diagnosed with cerebral palsy and spasticity.

When your child is injured as a result a doctor’s failure to detect a condition that causes brain damage, you can and should consider your legal options. For more details about birth injury litigation, please call Stern Law, PLLC at (800)462-5772.

What is periventricular leukomalacia?

PVL can arise during pregnancy, labor or delivery. It is sometimes described as the result of a lack of oxygen or blood flow to the brain, causing necrosis, or tissue death in the brain, creating holes or empty spaces.

The periventricular area – or the area around the spaces in the brain called ventricles – contains nerve fibers that transmit information between the nerve cells and the spinal cord, as well as from one part of your child’s brain to another. When PVL occurs, the area damaged by the condition affects the nerve cells responsible for controlling motor movements. As such, your child may be left with serious and sometimes life threatening challenges.

Generally, there are a variety of causes of PVL. However, experts believe that certain types of maternal infections place a woman at higher risk for giving birth to a child with PVL. To illustrate, membranes around the fetus are affected by the release of toxins, which travel through the amniotic fluid surrounding a fetus to selectively injure areas of the developing brain. These toxins also cause premature rupture of the membranes, premature birth and other life threatening complications.

When does periventricular leukomalacia typically occur?

Researchers have been able to identify the stages of fetal development in which an unborn baby is particularly susceptible to PVL. Although there is some level of disagreement in the scientific community, experts believe that an unborn baby is particularly vulnerable to PVL somewhere between 26 and 34 weeks gestation. In fact, premature birth is a high risk factor for PVL, which is most common in infants born prior to 32 weeks.

What are the risk factors and causes associated with periventricular leukomalacia?

While it is not 100 percent clear as to why PVL occurs, it is believed that decreased blood flow in the brain may cause the condition. Overall, there are a number of causes and risk factors associated with PVL, such as:

  • Placental abnormalities
  • Maternal hypotension
  • Intraventricular hemorrhage
  • Hypoxemia
  • Acidosis
  • Mechanical ventilation of a newborn
  • Carrying multiples
  • Maternal bleeding
  • Sepsis during pregnancy or at birth
  • Premature rupture of the amniotic sac
  • Maternal drug use
  • Chorioamnionitis, or a bacterial infection of the fetal membranes – specifically, the chorion and amnion
  • Funisitis, or the inflammation of the connective tissue of the umbilicus

What are the symptoms of periventricular leukomalacia?

PVL can be rather challenging to diagnose in infants, as they usually do not manifest the telltale signs and symptoms of the condition until at least a month after birth. While each infant may experience symptoms differently, the most commonly reported signs and symptoms of PVL are as follows:

  • Developmental delays
  • Visual impairment and dysfunction
  • Hearing impairment
  • Impaired coordination
  • Spastic diplegia, or Little’s disease, causing muscle and limb tightness
  • Paralysis

How is periventricular leukomalacia diagnosed?

Typically, a cranial ultrasound, MRI or CT scan can readily identify whether a child has PVL. However, it is important to keep in mind that it could take several weeks after birth for PVL manifest itself in a more noticeable way. Hence, doctors usually wait at least 30 days before conducting tests to confirm a diagnosis of PVL.

What is the treatment for periventricular leukomalacia?

Newborns who have been diagnosed with PVL or who are at risk for developing the condition require special care once they have been discharged from the hospital. Medical professionals should conduct numerous developmental examinations if PVL is suspected.

Generally, treatment of PVL is focused upon symptom management. The methods medical personnel use to control the condition include the following:

  • Regular massage therapy
  • Physical therapy
  • Occupational therapy
  • Speech-language therapy and treatment and therapy to improve visual and hearing impairments

If you suspect your child was diagnosed with PVL as a result of medical negligence, it is important to consider your legal options. It’s also helpful to understand that as the parent of a child with a birth injury, you are not alone. Stern Law, PLLC is here to help: Please call (800)462-5772 to speak with an experienced attorney who can evaluate your case for free.