eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Periventricular Leukomalacia: Differential Diagnoses & Workup

Author: Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Coauthor(s): James C Brown, MD, Codirector of Pediatric Radiology, Assistant Professor, Department of Radiology, Creighton University School of Medicine
Contributor Information and Disclosures

Updated: Feb 14, 2008

Differential Diagnoses

Periventricular Hemorrhage-Intraventricular Hemorrhage

Other Problems to Be Considered

Intraventricular hemorrhage
Periventricular hemorrhagic venous infarction

Workup

Imaging Studies

  • Cranial ultrasonography
    • Cranial ultrasonography is the modality of choice for the initial evaluation of hypoxic-ischemic damage of the CNS in premature infants. Ultrasonography may be performed in the NICU without the need to transport fragile infants.
    • The earliest ultrasonographic appearance of periventricular leukomalacia (PVL) is abnormal increased echotexture in the periventricular white matter. This is a nonspecific finding that must be differentiated from the normal periventricular halo and mild periventricular edema that may not result in permanent injury.
    • The abnormal periventricular echotexture of PVL usually disappears at 2-3 weeks. Approximately 15% of infants experiencing PVL demonstrate periventricular cysts first appearing at 2-3 weeks after the initial increased echodensities.
    • The severity of PVL is related to the size and distribution of these cysts. Initial cranial ultrasonographic findings may be normal in patients who go on to develop clinical and delayed imaging findings of PVL.
  • CT scanning: CT scanning is not a first-line modality in evaluating these fragile premature infants in the first weeks of life. CT scanning may be helpful to better evaluate the extent and severity of PVL. Findings include ventriculomegaly involving the lateral ventricles with irregular margins of the ventricles and loss of deep white matter.
  • MRI: Like CT scanning, MRI does not play a major role in the early evaluation of PVL. MRI is most helpful in monitoring infants with suspected PVL and evaluating infants who develop clinical signs suggestive of PVL. MRI demonstrates the loss of white matter, abnormal signal intensity of the deep white matter, and ventriculomegaly. MRI demonstrates thinning of the posterior body and splenium of the corpus callosum in severe cases of PVL. Volumetric MRI scanning is also helpful in determining the extent of injury to the descending corticospinal tracts. A relationship between the degree of injury to the descending corticospinal tracts as assessed by MRI and the severity of diplegia has been reported.

Other Tests

  • EEG

Histologic Findings

  • PVL lesions demonstrate widespread loss of oligodendrocytes and an increase in astrocytes.

More on Periventricular Leukomalacia

Overview: Periventricular Leukomalacia
Differential Diagnoses & Workup: Periventricular Leukomalacia
Treatment & Medication: Periventricular Leukomalacia
Follow-up: Periventricular Leukomalacia
Multimedia: Periventricular Leukomalacia
References
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References

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  2. Wiswell TE, Graziani LJ, Kornhauser MS, et al. Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics. Nov 1996;98(5):918-24. [Medline].

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Further Reading

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Keywords

periventricular leukomalacia, PVL, ischemic brain injury, cerebral palsy, CP, hypotension, ischemia, coagulation necrosis, intracranial hemorrhage, ICH, hypocarbia, vasculitis, chorioamnionitis, cytokines, white matter damage, spastic diplegia, quadriplegia, nystagmus, strabismus, blindness, retinopathy of prematurity, maternal chorioamnionitis, respiratory distress syndrome, pneumonia, patent ductus arteriosus, placental vascular anastomoses, twin gestation, antepartum hemorrhage, sepsis

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Contributor Information and Disclosures

Author

Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Terence Zach, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

James C Brown, MD, Codirector of Pediatric Radiology, Assistant Professor, Department of Radiology, Creighton University School of Medicine
James C Brown, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Radiology, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Scott S MacGilvray, MD, Associate Professor, Department of Pediatrics, East Carolina University School of Medicine
Scott S MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Head, Division of Neonatal-Perinatal Medicine, Professor, Departments of Pediatrics and Obstetrics/Gynecology, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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