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Periventricular leukomalacia

Author
Geoffrey Miller, MD
Section Editors
Joseph A Garcia-Prats, MD
Douglas R Nordli, Jr, MD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Periventricular leukomalacia (PVL) refers to injury of cerebral white matter that occurs in a characteristic distribution and consists of periventricular focal necrosis, with subsequent cystic formation, and more diffuse cerebral white matter injury [1]. PVL is the major form of brain white matter injury that affects premature infants, and is associated with the subsequent development of cerebral palsy, intellectual impairment, and visual disturbances. (See "Epidemiology, etiology, and prevention of cerebral palsy".)

This topic will discuss the epidemiology, pathophysiology, pathology, diagnosis, and management of PVL.

HISTORY

The lesions of PVL were described more than 100 years ago [2]. Parrot recognized the periventricular lesions as infarcts called "cerebral stéatose" [3]. Banker and Larroche used the term "periventricular leukomalacia," described the neuropathological changes that corresponded to coagulation necrosis, and defined the clinicopathological correlations [4].

EPIDEMIOLOGY

PVL is more common in premature than term infants, and occurs more frequently with decreasing gestational age and size. The greatest period of risk for PVL is under 32 weeks of gestational age [5]. PVL also occurs in late preterm and term infants [6]. In the United States, infants born at less than 32 weeks account for about 2 percent of all live births, and very low-birth-weight infants (<1500 g) account for about 1 percent of all live births [7]. (See "Incidence and mortality of the preterm infant", section on 'Incidence'.)

The incidence of PVL varies among centers and between survivors and nonsurvivors. The use of different ultrasonographic criteria (eg, echodensities or echolucencies) or MRI criteria contributes to this variability.

                          

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Literature review current through: Nov 2016. | This topic last updated: Sat Jan 16 00:00:00 GMT+00:00 2016.
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