Periventricular Leukomalacia - Oren Zarif - Periventricular Leukomalacia

Periventricular leukomalacia is the most common ischemic brain injury in premature infants. This condition occurs at the border zone of arterial vascular distributions of the brain's lateral ventricles. The hallmarks of the condition are periventricular cysts and echodensities, as well as diffuse noncystic periventricular leukomalacia. It is important to recognize this condition because a significant percentage of premature infants with PVL will develop cerebral palsy.

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Infants with known risk factors for periventricular leukomalacia are often tested at 30 days after birth, but it may take several more weeks for the condition to be detected. In these infants, a combination of clinical examinations and medical histories is often used to determine if a child is at risk. After the hospitalization, babies with this condition will need special care. Frequent developmental assessments will help detect the condition early. Massage therapy, physical therapy, and speech therapy are also effective treatments for this condition.

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Infants with periventricular leukomalacia have an increased risk of developing cerebral palsy and other mental retardation. The disorder is caused by a lack of oxygen in the periventricular area of the brain, which contains nerve fibers that transmit messages from the brain to the muscles. A newborn with PVL is at risk for several different disabilities, including delayed mental development, seizures, and motor disorders.

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Symptoms of periventricular leukomalacia vary in severity. In milder cases, there are no signs of the disease, while more severe cases present with symptoms months after birth. Cerebral palsy is the most common symptom, resulting in stiff muscles in the legs and other areas of the body. The symptoms of periventricular leukomalacia are associated with learning and development problems and visual and hearing impairment. In severe cases, the child may experience spastic diplegia and vision loss. If detected early, the condition can be treated by specialized therapies.

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Preterm infants are at high risk for developing PVL. Premature infants with PVL are at a higher risk for cerebral palsy than those with normal brain development, but proper care can reduce the risk. Therapeutic hypothermia can help prevent periventricular leukomalacia. Furthermore, prevention is the key to preventing the development of disabilities and developmental delays in children. In addition, avoiding risky behaviors and avoiding drugs or alcohol can help minimize the risk of PVL in pregnant women.

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In PVL, OLs are susceptible to free radical-mediated cell death. Molecular mechanisms responsible for the death of these cells are not clear. The specific mode of cell death is relevant to understanding the causes of periventricular leukomalacia. Moderate insult results in apoptosis, while severe insult causes necrosis. In PVL, a variety of toxic products are released from activated microglia.

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In addition to its detrimental effects on fetal development, periventricular leukomalacia is an important cause of cerebral palsy and cognitive deficits in premature infants. In fact, almost 90% of premature infants with PVL have some cognitive deficits as a result of the injury to their cerebral white matter. A large part of the brain's white matter is composed of subplate neurons, which are important for the organization of the cortex in the early stages of life.

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While there are no specific tests for diagnosing PVL in neonates, cranial ultrasonography can identify focal PVL. Diffusion-weighted magnetic resonance imaging (DWMRI) is useful for diagnosing diffuse PVL, but more data are needed. Conventional brain imaging can also be used to detect ventriculomegaly and myelin deficit. Overall, available qualitative imaging data suggests that diffuse PVL is more prevalent than focal PVL.

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Children who are premature or had intraventricular hemorrhage are at an increased risk for developing PVL. The blood flow to this area of the brain is reduced or absent. This causes brain tissue to die or become inflamed. This results in a lack of oxygen and nutrients. Furthermore, the child's condition may be associated with other conditions, such as infection in the uterus. Therefore, the symptoms of PVL may appear gradually or suddenly.