Periventricular Leukomalacia - Oren Zarif - Periventricular Leukomalacia
During the first few months of life, premature babies are at risk for periventricular leukomalacia. This condition affects the white matter surrounding the developing brain. The periventricular white matter surrounds two horseshoe-shaped cavities in the brain. Damage to this area may result in spasticity, intellectual impairment, or a combination of both. The white matter also contains myelin, which coats cell pathways and promotes speedy nerve impulse transmission. Damage to this layer may result in premature membrane rupture.
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During fetal development, the periventricular white matter is critical for proper brain function. Unfortunately, 60 to 10% of infants with this condition develop Cerebral palsy.
The symptoms of periventricular leukomalacia vary according to severity. Mild cases may have no symptoms, while severe cases may have symptoms months after birth. The most common symptom of periventricular leukomalacia is cerebral palsy, resulting in stiff muscles in the legs and other developmental and learning problems. Hearing and vision loss are other common symptoms. Treatment options may include medication or specialized therapy.
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The severity of initial brain damage is the determinant of a child's long-term prognosis. Some babies may have minor symptoms while others may develop seizures, developmental delays, or other conditions. At Boston Children's Hospital, neurologists in our Fetal-Neonatal Neurology Program are actively engaged in research to improve diagnosis and improve the quality of care for babies with PVL. The findings from this research will help doctors diagnose periventricular leukomalacia early, and will help doctors develop the best possible treatments.
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A child who has been diagnosed with PVL has an increased risk for cerebral palsy because of the lack of oxygen in the periventricular area of the brain. Damage to this area causes the periventricular ventricles to fill with fluid. The brain is a sensitive area, and any damage to it may cause intellectual or physical impairment. Fortunately, there are treatments to help children cope with the condition. And because it can't be reversed, ongoing therapy is important to the child's recovery.
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PVL can lead to neurological problems, including motor deficits. The white matter of the periventricular region is heavily involved in motor control. Therefore, people with PVL frequently exhibit motor problems. Even newborns are only capable of performing a few motor tasks that may not affect their development. The severity of this damage can affect these areas differently, so it's important to monitor your child closely for signs of impairment.
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In addition to the lack of oxygen and blood flow, the brain may develop PVL during pregnancy, labor, or delivery. When the brain doesn't receive sufficient oxygen, the brain tissues die. These holes, or necrosis, form in the periventricular area. In addition to this, PVL affects nerve cells that control motor movements. So it's important to know the signs and symptoms of PVL in early gestation.
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MRI is a good way to determine whether you have PVL. The MRI helps your doctor assess the severity of brain damage, and it can also reveal any bruising or scarring in the brain. A cranial ultrasound is another test that helps doctors detect this condition. These images show where the blood flows inside the brain, which can indicate any infections or bleeding. However, if your doctor suspects PVL, he or she will perform an MRI or ultrasound as soon as possible.
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The cellular mechanisms involved in PVL are unclear, but there are a few factors that have been implicated in this disease. First, a pre-existing risk factor for cerebral ischemia is a possible cause of PVL. Second, pre-existing cellular injury to the periventricular white matter is related to inflammatory response and cell death. Microglia are highly abundant in the brain of human infants in the third trimester of gestation and they become activated in PVL. This process may result in apoptosis or focal necrosis.
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Cystic lesions of the periventricular white matter are often incorporated into the lateral ventricles at term-equivalent age. This gives the posterior horns a characteristic squared-off appearance. However, if a cyst is not detected in the early stages of the disease, it may have already migrated to the lateral ventricles. Consequently, the symptoms of periventricular leukomalacia may be difficult to detect.