Periventricular Leukomalacia - Oren Zarif - Periventricular Leukomalacia
While most patients who are diagnosed with periventricular leukomalacia do not have any symptoms at birth, severe cases may be symptomatic months after the diagnosis. The most common symptom of periventricular leukomalacia is cerebral palsy. This disorder causes a stiffness of the muscles in the legs and results in difficulty in moving, learning, and developing. Other symptoms include hearing loss, vision problems, and coordination issues. There is no specific cure for periventricular leukomalacia, but it can be treated with specialized therapies.
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The periventricular leukomalacia process is characterized by the damage or death of cells in the white matter. Damage to this area is a strong predictor of cerebral palsy. Although the symptoms of periventricular leukomalacia vary according to the amount of cell death, most children with this disease will have cognitive deficits. If left untreated, however, periventricular leukomalacia may progress to the more severe forms of cerebral palsy.
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The condition can occur in preterm infants. While the incidence of cystic periventricular leukomalacia has decreased, approximately 60% of premature infants with the disorder will develop cerebral palsy. Conventional T1 and T2-weighted MRI (dMRI) is useful for identifying cystic lesions in the periventricular white matter. The cysts are typically located in the centrum semiovale. A dMRI will show the presence of restricted diffusion in the white matter around the fetus prior to the formation of the cysts. The evolution of the cysts is heterogeneous, with established cysts adjacent to regions of the white matter that have been involved recently.
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Patients with periventricular leukomalacia should undergo a physical examination and complete a medical history. Additional testing may be necessary. Diagnostic procedures include MRIs that provide detailed images of the brain and spinal cord. Magnetic resonance imaging (MRI) and cranial ultrasound are two of the most common tests used to diagnose periventricular leukomalacia. The results of these tests will help determine whether the condition is more severe or less severe.
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Symptoms of periventricular leukomalacia include intellectual impairment, spasticity, and motor delays. Children who develop cerebral palsy may experience a heightened risk of this condition. Fortunately, there are several treatment options to help children with this condition live as independently as possible. In addition to surgery, ongoing therapy can help children with the disorder live with the condition and minimize its effects. It is important to note that periventricular leukomalacia is not contagious and may be preventable.
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Patients with PVL are prone to cerebral palsy and hemorrhage in the periventricular region. The disease is often accompanied by a glial scar, but the symptoms of PVL can range from mild to severe. The most common symptoms of PVL are cerebral palsy and spastic diplegia. A brain ultrasound is necessary to diagnose the condition and to monitor any progression.
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Preterm infants are at risk for developing PVL. The medical team delivering the baby must take the appropriate precautions. During delivery, a doctor should be able to monitor the baby's heart rate and perform an emergency c-section if needed. Failure to do so may lead to brain damage and premature delivery. If the condition is not treated, it can result in severe disability. This condition may be life-threatening or cause death in the infant.
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Premyelinating oligodendrocytes (OLs) are prone to injury by free radicals. In preterm infants, OLs are selectively depleted in periventricular areas. Premyelinating oligodendrocytes also have a relative deficiency of superoxide dismutases. Both of these mechanisms likely contribute to cellular damage and death in PVL.
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PVL is caused by a lack of oxygen and blood flow to the brain. In addition to inadequate oxygenation and blood flow, it is often caused by maternal infection or rupture of the amniotic sac. PVL symptoms include spastic diplegia and periventricular leukoma. These symptoms are often life-threatening and require urgent care. They are very difficult to treat and can lead to death.
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The symptoms of PVL can occur before birth, during labor and delivery, and sometimes after birth, if the infant is delivered too early or has abnormal blood levels. Infants are most vulnerable to developing PVL when they are about 26 to 34 weeks pregnant, just before their scheduled delivery date. The physical characteristics of an infant at this time will determine the prognosis. Currently, there is no known cure for PVL, but early diagnosis and treatment can greatly improve the chances of recovery.