What is Periventricular Leukomalacia? Causes, Symptoms, Treatment, Prognosis, Prevalence, Prevention

Periventricular leukomalacia refers to the damage to the white matter around the ventricles. In case of any injury caused in the brain, the brain tissue around these ventricles dies and creates small holes in the brain. It is necessary to know about the causes, symptoms, treatment and prevention of periventricular leukomalacia.

What is Periventricular Leukomalacia?

What is Periventricular Leukomalacia?

Periventricular leukomalacia is a form of brain injury and one of the important causes of cerebral palsy and cognitive issues in premature infants.1 Various studies are being conducted to assess the use of better diagnostic methods and treatment modalities for Periventricular leukomalacia. Before we move on to the details of periventricular leukomalacia, let us understand the composition of brain and the related structures.

Brain is composed of many parts, out of which small cavities also make a very important component. These cavities are also called ventricular cavities which form the network within the brain parenchyma that is filled with cerebrospinal fluid. These help in communicating with different parts of the brain. The ventricular network is composed of 4 interconnected cavities. The ependyma cells present in the choroid plexus of these ventricles produce cerebrospinal fluid. This ventricular system is continuous with central canal of spinal cord. It facilitates the circulation of the CSF (cerebrospinal fluid) between the brain and spinal cord.

Periventricular leukomalacia is also referred by other names-

  • Encephalodystrophy
  • Leukomalacia
  • Ischemic necrosis
  • Periventricular infarction
  • Coagulation necrosis
  • Softening of the brain
  • Infarct periventricular white matter
  • Diffuse symmetrical periventricular leukoencephalopathy.

Causes of Periventricular Leukomalacia

Periventricular leukomalacia affects premature babies. The brain tissue of premature babies is more fragile. Hence the risk of Periventricular leukomalacia increases if the baby is born too early before the complete development. The babies born before completion of 32 weeks of gestation are more prone to this injury because of fragility. The death of brain cells is caused due to insufficient or interrupted blood flow to the particular region.

Though the exact cause to this condition is unknown, some of the possible causes of periventricular leukomalacia include

  • Premature birth and more fragile tissue
  • Infection when the baby is still inside the uterus
  • Intraventricular hemorrhage (bleeding inside the brain)
  • Amniotic sac of mother get ruptured because of some reasons earlier than the completion of gestation period
  • Low amniotic fluid
  • Uterine rupture
  • Placental problems.

Symptoms of Periventricular Leukomalacia

This injury is found more in premature babies than in babies who are born with complete development. Although the symptoms of Periventricular leukomalacia differ from one individual to another, some of the commonest symptoms of periventricular leukomalacia are listed below-

  • Abnormal Eye Movements and Problem with Vision- The individuals with Periventricular leukomalacia may fail to concentrate and maintain their steady gaze on a fixed object or point. The eyes would be involuntarily moving and hence sometimes called as ‘dancing eyes’. The vision is reduced or limited. Sometimes there would not be alignment of both eyes with each other. Even in some cases, the refractive errors like myopia, hypermetropia, presbyopia or astigmatism is detected because of failure in focusing light accurately onto the retina. This problem might be because of changed shape of the eye ball or defect in the lens.
  • Muscle Stiffness and Restricted Movement as a Symptom of Periventricular Leukomalacia- This may start at the age of one month. Delayed development continues throughout childhood and even continues in adulthood.
  • Occurrence of Seizures- In some infants seizures are also seen if they are born too early or have lower birth weights. This is one of the commonest symptoms of periventricular leukomalacia.
  • Bradycardia as a Sign of Periventricular Leukomalacia- Infants may have decreased heart rates.
  • Apnea– Breathing cessation may take place in some infants, which can be dangerous too.

Prevalence of Periventricular Leukomalacia

Periventricular leukomalacia is a damage in brain related to preterm infants. The risk increases according to the degree of prematurity. Problem with motor development, vision related problems and delayed brain activities continue with age.

Treatment for Periventricular Leukomalacia

Premature babies are usually underdeveloped. This is the main cause of the above condition. It is for this reason that there is no treatment for periventricular leukomalacia. It is really a challenge to the specialists to treat Periventricular leukomalacia as there would be continuous change in the brain of fetus and in neonatal stage. Keen observation of the overall development of the premature babies is what the hospitals provide. To be more precise, there will be close observation of development and functions of heart, lung, intestine and kidneys. The newborns would be treated in Neonatal Intensive Care Unit.

Treatment of periventricular leukomalacia mainly depends on the symptoms. Also, careful observation and regular assessments also form an important part of the treatment for Periventricular leukomalacia. Keeping a watch on the developmental milestones, screenings for brain and eye abnormalities and working towards overall growth and development. Early development and use of rehabilitation or assistive therapies may also help in the treatment of periventricular leukomalacia to some extent.

Prognosis of Periventricular Leukomalacia

The severity of periventricular leukomalacia varies depending on the extent of damage caused to the white matter. Usually delayed development of motor and vision problem is common in minor damage of white matter. The severity increases if the damage to the white matter is increased. This may lead to quadriplegic condition where all the four limbs are paralyzed after some years. Some infants suffer from cerebral palsy after a few years of age if the damage to the white matter is too high. In rare cases, the infants may get epilepsy in severe damage.

Prevention of Periventricular Leukomalacia

Though it is difficult to prevent the above condition to happen, some measures which could be followed to avoid Periventricular leukomalacia are given below-

  • During birthing process, if the supply of oxygen is decreased, the infants have the chance of having Periventricular leukomalacia. Hence it is seen that sufficient supply of oxygen is maintained and the birth process is performed with utmost care.
  • Prevention of hypocarbia and hypoxemia is needed.
  • Abnormal blood pressure must be monitored and managed.
  • Some researches show that if a steroid called betamethasone is given to mother, it can decrease the chance of occurrence of Periventricular leukomalacia in baby. 2
  • Another compound which acts as neuroprotective is Magnesium sulfate. It can be given to avoid Periventricular leukomalacia.

Conclusion

Periventricular leukomalacia is an injury to the white matter of the brain of premature babies. Proper diagnosis and timely treatment promises the good improvement in the condition. Failure to do so may result even in fetal death. Treatments are specific to the individuals. The kind and duration of treatment for Periventricular leukomalacia depends on the extent of damage of white matter. Since the risk of the condition increases with the extent of prematurity, more care is to be taken for expecting mothers. Proper balanced diet, healthy life style, required exercise can bring about healthy birthing process and most of the disorders related to the development of brain of infants can be avoided. Antenatal steroid like betamethasone can reduce the risk of periventricular leukomalacia to some extent.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/18852342
  2. https://www.ncbi.nlm.nih.gov/pubmed/11152922

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