Ministry of Health

NZ Government

    
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Periventricular Leukomalacia (PVL or PVLM) is an ischaemic brain injury typically seen in preterm infants as part of cranial ultrasound screening.  The exact aetiology is postulated to be multifactorial, with factors such as a particularly vulnerable vascular network, poor cerebral vascular autoregulation, the vulnerability of premature newborn infant white matter, and intrauterine infection or inflammation.

Cystic lesions are typically not present within the first week, although often in the first week there is some hyperechogenicity of periventricular white matter.  In many  infants, this resolves without subsequent development of cystic PVLM.  However, in some infants cystic change develops over the ensuing weeks.  Cystic changes tend to be lateral and superior to the lateral ventricles, usually involving the parietal regions and extending posteriorly.  This is in contrast to the extent and position of isolated frontal horn cysts (which are not associated with significant long-term problems).

Neurodevelopmentally, there is a high risk of subsequent impairment in survivors.  Prognosis depends on how extensive the lesions are, as well as location.

The following images are from an infant born at 30 weeks.  He had a relatively stable immediate neonatal course and head scans were performed as part of his routine care.

Week 1 Scan

		The images are standard views taken in the first week for routine screening. There is no evidence of GM-IVH. There is no obvious abnormality to see although, in hindsight, the periventricular areas may be a little echogenic.

One Month Scan

		The routine scan at one month of age shows bilateral cystic change lateral and slightly superior to the lateral ventricles. There is also prominence of the subarachnoid space, possibly representing cerebral atrophy.

Two Month Scan

		There is now extensive cystic change lateral and slightly superior to the lateral ventricles.  This degree of leukomalacia involves the major motor tracts and will result in severe motor disability. There is further prominence of the subarachnoid space and the lateral ventricles are also generous.