What is periventricular leukomalacia (PVL)?
Periventricular leukomalacia (PVL) is a birth injury affecting the periventricular white matter, a type of brain tissue below the brain’s cortex. White matter contains nerve fibers (axons), which are extensions of nerve cells (neurons).
White brain matter generates nerve impulses to control voluntary movement. This brain matter also contains ventricles (hollow areas) filled with cerebrospinal fluid (CSF), which protect the brain and spinal cord from impact and shock.
Damage to white matter in the baby's brain before, during, or shortly after birth can lead to PVL and cause spastic movements, cognitive impairment, and vision issues.
This type of brain injury usually occurs during the third trimester of pregnancy. Premature birth, low birth weight (less than 5 pounds, 8 ounces), and instances of intraventricular hemorrhage (brain bleeds) can make PVL more likely.
Causes of periventricular leukomalacia
Periventricular leukomalacia develops when white tissue in the developing brain has died or been damaged from lack of blood flow.
PVL may be linked with intraventricular hemorrhage, which involves bleeding in the brain's ventricles and reduces oxygen supply to the white matter. This can occur before, during, or shortly after childbirth.
There are several other risk factors that can harm this area of the brain and cause periventricular leukomalacia.
Risk factors for PVL include:
- Hypoxic-ischemic encephalopathy: This occurs due to limited blood flow or lack of oxygen to the brain, resulting in brain dysfunction.
- Infection: Newborns have a high risk of neonatal infections that activate the immune system and may result in PVL.
- Low birth weight: Premature infants, as well as children weighing less than 5 pounds, 8 ounces, have underdeveloped, fragile brains and a higher risk of developing PVL.
Speak to one of our registered nurses if you had a difficult birth and believe your child suffered from brain damage and is showing abnormalities. Our caring team can help you determine how to get your child the treatment they deserve.
Kristin Proctor, RN
Registered Nurse for 20+ Years
Periventricular leukomalacia symptoms
Periventricular leukomalacia symptoms can vary depending on the degree of white-matter damage in the brain.
Children diagnosed with mild cases of PVL may not show any physical symptoms, but may show cognitive developmental delays.
Common symptoms of PVL may include:
- Exaggerated, jerky movements
- Knees and thighs pressed together or crossed while walking
- Tight muscles in legs
- Walking on tiptoes
A common diagnosis with moderate to severe periventricular leukomalacia is spastic diplegia, a type of cerebral palsy. This type of cerebral palsy is characterized by stiff, jerking movements in the arms and legs.
Periventricular leukomalacia symptoms and disabilities may not be apparent until the child is a few months old. Children with PVL have a high likelihood of also being diagnosed with cerebral palsy and learning disorders.
As the child gets older, these physical symptoms may progress into other areas of the body due to muscle fatigue caused by the tightened and contracted muscles.
These symptoms can greatly impact a child’s ability to move freely due to the ongoing stress on their muscles, joints, and ligaments.
Symptoms are usually seen in the legs more than the arms and the face unless the PVL is severe, and then vision and hearing are also affected.
Diagnosing periventricular leukomalacia
It is important to get a proper periventricular leukomalacia diagnosis, since this condition may be mistaken for other ones that cause tightened muscles.
The first step in diagnosing PVL is a physical examination to look for signs of muscle spasticity and any brain damage.
If your doctor suspects your child has PVL, they will use imaging tests such as MRI (magnetic resonance imaging) scans and cranial ultrasounds to look for brain damage.
The MRI scan will be able to determine how badly the brain was damaged. It may allow doctors to see bruising or scarring on the brain. The cranial ultrasound reflects images of the brain’s surface and ventricles, allowing doctors to find any damage.
Once the doctor has confirmed a periventricular leukomalacia diagnosis and determined its severity, they will be able to estimate your child's prognosis.
Periventricular leukomalacia prognosis
A periventricular leukomalacia prognosis is the long-term outcome of the condition. A PVL prognosis can vary depending on the damage to the white brain tissue and how severe the symptoms are.
It's not possible to reverse the brain damage that causes PVL, so the condition will not improve on its own over time.
However, children with mild periventricular leukomalacia can go on to lead independent lives and may experience an improved quality of life with proper treatment.
Children diagnosed with severe periventricular leukomalacia may need more long-term medical treatment and assistance to complete daily activities and manage painful symptoms.
If you believe your child suffered from a preventable birth injury caused by improper care during childbirth, contact us to learn more about your next steps.
Treatment options for periventricular leukomalacia
Because periventricular leukomalacia is caused by irreversible brain damage, there is no way to treat the physical damage of the white brain matter.
However, there are several treatment options available to manage physical, neurological, and cognitive symptoms caused by PVL. These treatment options aim to relieve pain and improve quality of life.
Treatment options to manage periventricular leukomalacia symptoms include:
- Occupational therapy: Improves fine motor skills used to complete daily tasks such as brushing teeth, changing clothes, and bathing
- Physical therapy: Helps to relax tightened muscles and improve overall mobility through a series of physical exercises
- Speech therapy: Refines language and communication skills in children with speech delays
It is important to remember each case of PVL is different. Your doctor will be able to determine which treatment options are best for your child based on their individual needs.
Taking legal action for periventricular leukomalacia
Unfortunately, some cases of periventricular leukomalacia (PVL) could have been prevented with proper care during the birthing process.
Doctors, nurses, and other types of health care providers have a duty to uphold a high standard of care in the delivery room. This includes navigating difficult birthing situations to make sure the child is delivered safely.
Medical professionals who commit medical negligence that leads to PVL should be held accountable for their actions. Many families may be able to take legal action through a birth injury lawsuit. Compensation won in a lawsuit can help families pay for the cost of care to treat their child’s condition.
If you believe your child developed periventricular leukomalacia due to medical negligence, you may be able to pursue legal justice. Learn more about your legal options and get a free case review today.
