PERIVENTRICULAR LEULOMALACIA: ULTRASOUND DIAGNOSIS AND FLLOW-UP

Abstract

Periventricular leukomalacia (PVL) is defined as ischemic infarction of the white matter located around the lateral ventricles of the premature infant's brain. PVL is caused by the hypoperfusion of end arteries that supply the white matter in the watershed areas between the major cerebral arteries. From January 1984 to October 1988, 506 newborns with a gestational age ≤ 34 weeks, admitted to NICU of Padua were routinely scanned. Thirthy newborns (5.9%) were diagnosed to have cavitary PVL. Concomitant PVH-IVH occurred in 14 infants (46.77%). Twenty-seven babies survived and 3 died. Twenty-four (80%) of the 30 newborns showed areas of increased echogenicity in the periventricular regions prior to the development of cystic changes. The mean age for the appearance of hyperachogenicity was 3 days (range 1-26). The mean age for the appearance of cysts was 23 days (range 8-521. PVL was divided into localized and extensive lesions. Twenty newborns had localized PVL, 13 unilateral (2 frontal, 4 parietal 7 occipital) and 7 bilateral (2 frontal, 5 occipital). Ten newborns had extensive and bilateral PVL (8 frontal, 9 parietal, 10 occipital). Discharged babies were followed-up by repeated ultrasound scans. In 14 infants followed beyond 6 months postnatal age the cysts disappeared, in 6 they were still visible. Fifteen infants had associated mild-moderate ventricular dilation, 5 had cerebral atrophy. The 12 months (corrected age) neurodevelopmental outcome of 17 survivors is reported. Eleven babies showed cerebral palsy, 4 of them had a severe mental delay, 3 a moderate mental delay and 4 were normal. One baby showed a mild showed delay and a normal mental development. Five babies had a normal motor development, 1 of them had a moderate mental delay and 4 were normal. In conclusion, PVL is related with a poor neurodevelopmental outcome, particularly when lesions are extensive, localized and bilateral, above all when the occipital lobe is envolved.