Atlas of Neonatal Pathology: Periventricular leukomalacia (PVL)

+ Introduction

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+ Neonatal pathology

Periventricular leukomalacia (PVL)

Introduction

Periventricular leukomalacia means infarction of the periventricular white matter.

The periventricular area is particularly vulnerable to hypoxic-ischemic injury because of high metabolic rate and watershed blood supply (boundary between the ventriculopetal and ventriculofugal arteries within the brain, the latter are poorly developed in premature infants) The lesion is common in preterm infants, 28 – 32 weeks is the highest incidence.

Etiology

ischemic injury following birth asphyxia, prolonged apnea
additional risk factors include chorioamnionitis, sepsis, meningitis
PVL can develop several weeks after birth

Clinical signs

Nonlethal but most frequent cause of cerebral palsy in survivors. Spastic diplegia is the most common clinical presentation. Diagnosed using cranial ultrasound.

Macroscopic appearance

white spots of coagulation necrosis located in the periventricular white matter of the centrum semiovale
bilateral symmetric distribution is common
breaking into pseudocysts (cystic PVL) or healing with gliotic scar

Pictures

Cystic periventricular leucomalacia in 6-weeks old infant. Elective premature delivery at 32 weeks because of severe hydrops universalis. The cause of hydrops was not found. Sepsis occured during the stay in the neonatal intesive care unit and the baby died of protracted septic shock. Periventricular leucomalatia, Macro, autopsy (73866) Periventricular leucomalatia, Macro, autopsy (73867) Periventricular leucomalatia, Macro, autopsy (73868) Periventricular leucomalatia, Macro, autopsy (73869) Periventricular leucomalatia, Macro, autopsy (73870)