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Periventricular Leucomalacia (PVL)

Periventricular leucomalacia (PVL) is a condition in which decreased blood flow to brain tissue causes it to soften up and eventually die, leaving behind cysts filled with fluid. Over time, these cysts may fuse together or collapse altogether. The affected brain tissue and the nerve fibers that run through it help to control body movement; their loss will have an impact on this ability.

Risk factors for PVL include moderate and severe IVH, infections within the womb, asphyxia, and a lengthy resuscitation following birth. Although the brain tissue damage may have occurred before birth, during delivery, or in the immediate days following birth, the cysts take several weeks to appear, delaying a definitive diagnosis. About 75% of premature babies diagnosed with PVL will go on to have some form of disability. In general, the more mild the case, the less severe the disability will be. Very mild cases of PVL may have no lasting disability at all.

In general, PVL leads to motor disorders, the most common of which is cerebral palsy (CP). Often, the brain tissues affected by PVL are those that control the legs, though if the damage is more extensive, one can expect that other parts of the body, including the arms and face, will be affected.

The range of severity for CP is large; the mildest cases are not disabling, will not interfere with a child’s quality of life, and may be barely noticeable. Severe cases of CP may cause major disability, including an inability to walk and difficulty with speaking and eating. Mental delay will also be associated with more severe forms of cerebral palsy.

More information

Hilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC