Pvl Periventricular Leukomalasia

Periventricular leukomalasia (PVL)

My son Riley was born on November 14, 1999 at 33 weeks gestation.   He was diagnosed with PVL at birth. Periventricular leukomalasia (PVL) is a type of brain injury involving an ischemic infarction, which is caused by inadequate blood circulation of the white matter of the brain adjacent to the lateral ventricles. Peri means near; ventricular refers to the ventricles or fluid spaces of the brain, leukomalasia is softening of the white matter of the brain. The softening occurs because brain tissue in this area has died. Since PVL results in the loss of vital areas of neural tissue, particularly motor fibers that control muscle movements, cerebral palsy also referred to as CP develops in most cases. It is likely to be of a moderate to severe degree and either spastic diplegia or spastic quadriplegia, with the legs more involved than the upper extremities. Mild to severe mental retardation may occur, but some children with PVL and spastic CP have normal intelligence. However, they will have learning disabilities secondary to their motor delays, because children learn by doing. Visual impairment is also possible if the injury involves the occipital region. Seizure disorders may occur but are not commonly associated with PVL.
After the injury, necrosis occurs (tissue death). While the body works to clean out the dead tissue (a process called phagocytosis), cysts develop, which are visible via a head ultra sound, CT scan or MRI (magnetic resonance imaging). Motor and cognitive outcomes have been associated with the presence, location and extent of periventricular cysts. Ultra sounds are used routinely in the NICU, because it is easier and can be done at the bedside.
Reabsorption of the cysts may occur over a period of months, and then the ventricles (fluid filled spaces in the brain) take over the space of the lost brain tissue. This was seen as significantly enlarged ventricles (ventriculomegaly) on Riley’s MRI, which was done...