Periventricular Leukomalacia

  • Overview

    Benjamin C. Warf, MD, director of Neonatal and Congenital Anomaly Neurosurgery at Boston Children's Hospital

    At Boston Children’s Hospital, our specialists have already helped many infants diagnosed with periventricular leukomalacia (PVL), a type of brain injury most common in very premature babies. 

    Here are the basics of PVL:

    • PVL is injury to the white matter around the fluid-filled ventricles of the brain. White matter transmits information between nerve cells, the spinal cord and from one part of brain to the other
    • PVL is common in very premature, low birth weight babies. It is the second most common complication involving the central nervous system in premature infants.
    • PVL can cause damage to the nerve pathways that control motor movements, resulting in muscles that are tight, spastic or resistant to movement, in addition to being weak.
    • There is no treatment for PVL and the prognosis varies depending on the severity of the damage to the brain.

    How Boston Children’s approaches PVL:

    Clinicians in Boston Children’s Fetal Neonatal Neurology Program provide early and accurate diagnosis of PVL and other brain injuries acquired by newborns and young infants. We follow newborns who’ve been seen in the Neonatal Intensive Care Unit (NICUs) at Boston Children’s as well as other hospitals. After your baby has been discharged from the NICU, we continue to monitor his neurological progress to provide treatments that will help his long-term development.

     

    Periventricular leukomalacia: Reviewed by Benjamin C. Warf, MD
    © Boston Children’s Hospital; posted in 2012

    If you are at risk for preterm delivery, specialists in our Advanced Fetal Care Center can help you to reduce the risks of PVL and its complications.
    Boston Children's Hospital 
    300 Longwood Avenue
    Pavilion 2
    Boston MA 02115

     617-355-3896
     fax: 617-730-0302

    If your child is premature and has developed PVL, our Development Medicine Center will work with your family to treat and manage the associated intellectual and learning difficulties that may be associated with the condition.
    Boston Children's Hospital 
    300 Longwood Avenue
    Boston MA 02115

     617-355-7025

    Treatment of a complication of PVL, intraventricular hemorrhage, or bleeding inside the brain, can be managed through our Neurology Department.
    Children's Hospital Boston
    300 Longwood Avenue
    Fegan 11 and Hunnewell 2
    Boston MA 02115

     617-355-6388
  • In-Depth

    Boston Children’s Hospital provides thorough, specialized care for babies with brain injuries such as periventricular leukomalacia (PVL) as well as other neurological conditions. Here is some basic information about PVL.  When you meet with our experts in the Fetal Neonatology Program, you’ll learn about your baby’s diagnosis and treatment options in more detail.

    What is PVL?

    PVL is a type of brain injury commonly found in babies who are very premature and have a very low birth weight. It is damage to the white matter around the fluid-filled ventricles of the brain. White matter transmits messages between different nerve cells and parts of the brain.

    What medical complications are associated with PVL?

    As a result, babies with PVL have a higher risk of cerebral palsy  (a very general label that describes a mixture of cognitive and motor dysfunction with a broad spectrum of severity). Babies with PVL are thus at an increased risk of having developmental delays and learning disorders.

    Causes

    What causes PVL?

    Although the exact cause of PVL is not known, the condition is thought to be caused when the areas of the brain around the ventricles (the fluid-filled spaces of the brain) don’t get enough blood. This area of the brain is very prone to injury, especially in premature babies whose brain tissue is fragile. The more premature a baby is, the higher the risk for PVL.

    Other factors that may be associated with PVL include:

     

    Symptoms

    What are the symptoms of PVL?

    Every child with PVL is unique and will have his or her own set of symptoms, which often become apparent over time as the child develops, rather than all at once.

    The most common symptoms of PVL are:

    • Trouble with vision and with eye movements.
    • Trouble with movement, and tight muscles
    • Developmental delay that is increasingly apparent over time

    What is the long-term outlook for my baby?

    The long-term outlook for babies with PVL depends upon the severity of the initial brain damage. The types of symptoms vary widely and can range from a child who has minimal problems to a child who has severe delays and problems with movement.

  • Tests

    At Boston Children’s Hospital, we know that an early and accurate diagnosis of periventricular leukomalacia (PVL) is the first step to getting your baby the care and support he needs.

    How is PVL diagnosed?

    Newborns may not show symptoms of PVL in the first few days of life. However, since premature infants have an increased risk of developing the condition, doctors may perform the following diagnostic tests:

    • Cranial ultrasound: a painless test that uses sound waves to view the baby's brain through the soft spot on top of the head (fontanel).
    • Magnetic resonance imaging (MRI): this imaging procedure uses a magnetic field and radio to produce a detailed picture of the brain without exposing the infant to x-rays. PVL is a term that describes the way the affected infant’s brain looks on an MRI
  • Clinicians in the Fetal Neonatal Neurology Program at Boston Children's Hospital provide comprehensive early and accurate diagnosis of periventricular leukomalacia (PVL) and other brain injuries acquired by newborns and young infants. Because newborns' brains are in a crucial window of rapid development, we identify problems as early as possible and act quickly to prevent as much damage as possible.

    How is PVL treated?

    Although there is no treatment for PVL, we may recommend other types of care for your child, such as:

    Most of these therapies are provided through Early Intervention programs in your community. Here at Boston Children's, we work to connect families to Early Intervention and support them in other ways such as transitioning  to another program in our hospital that specializes in caring for older children. 

  • Research & Innovation

    All of the neurologists in the Fetal Neonatology Program at Boston Children’s Hospital are actively engaged in research that helps us diagnose periventricular leukomalacia (PVL) and other neurological conditions quickly and accurately, understand them deeply and develop more effective treatments.

    Understanding and treating periventricular leukomalacia

    Boston Children’s neurologist, Joseph Volpe, MD, has made his life’s work the study of periventricular leukomalacia (PVL), a condition that is responsible for many cognitive, behavioral and motor disabilities in children born prematurely. Volpe’s work has helped doctors understand which infants are at risk for this sort of brain injury and how it could be prevented or treated. Volpe is considered by many to have founded the field of neonatal neurology. His textbook, Neurology of the Newborn, is a standard in the field.

    Children who develop PVL often have problems with their vision that is related to the brain injury instead of a problem with the eyes. This “cerebral visual impairment” can be difficult to diagnose and treat. It is important to identify this problem because these types of visual impairments can affect a child’s ability to learn in school. Janet Soul, MD, is conducting a research study of cerebral visual impairment in children who were born prematurely.
     

    To learn more

    If you want to look for other clinical trials going on throughout Boston Children’s, you can search here.

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