Diagnosis and evolution of periventricular leukomalacia: a study with real-time ultrasound

doi:10.1016/0378-3782(84)90090-2

Early Human Development

Volume 9, Issue 2, February 1984, Pages 105-109

https://doi.org/10.1016/0378-3782(84)90090-2 Get rights and content

Abstract

Periventricular leukomalacia is an ischemic lesion in periventricular white matter of premature infants. Hemorrhage into the ischemic area occurs in up to 25% of cases. We report two cases in which the diagnosis of periventricular leukomalacia was made during life with real-time ultrasound scanning. In one case, serial scans demonstrated the evolution of echodense regions, observed in the first 3 days of life, to cystic echolucent areas at 4 weeks. In the second case, periventricular echodense areas did not precede the occurrence of cystic echolucent lesions. This may reflect a more chronic ischemic cerebral insult (consistent with recurrent apnea and bradycardia) rather than a presumed acute episode of cerebral ischemia (with or without secondary hemorrhage) sustained by the first case. Real-time ultrasound scanning is a simple, non-invasive technique with which to document the evolution of periventricular leukomalacia, and thus to define the clinical neurological correlates in the neonatal period.

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Cited by (16)

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1989, Clinical Radiology
Cranial ultrasound (US) was used in 14 neonates to define three categories of extensive cystic leucomalacia, namely periventricular, mixed, and subcortical. The initial US findings were compared with serial magnetic resonance imaging (MRI) and the neurodevelopmental outcome of the children.
In the infants with periventricular leucomalacia, MRI showed a decrease in the size of the cystic areas with age. Six of these seven children showed an increase in the level of myelination upon follow-up examination, although white matter development was slower in the vicinity of the cysts. The lateral ventricles of these children were slightly enlarged and the occipital horns showed an irregular angular outline.
In the infants with mixed leucomalacia, MRI showed cystic areas which remained obvious at the final examination. Myelination was grossly delayed in these patients. The lateral ventricles were enlarged and remained unchanged, with the exception of one infant whose ventricles collapsed after shunt revision.
In the three children with subcortical leucomalacia, MRI confirmed shrinkage of the cysts in two of the three infants upon the first follow-up examination but thereafter the cysts remained unchanged. No supratentorial myelination was demonstrated in these patients. The ventricles were enlarged and the cortical sulci were prominent in all these infants.
A strong correlation was shown between the MRI appearances and the clinical outcome in these children. MRI may be most useful for making the diagnosis of cystic leucomalacia in children not submitted to US examination as neonates or in whom only some of the classical US features have been identified.
Perinatal asphyxia: Clinical aspects
1989, Clinics in Perinatology
This article reviews the significance of hypoxic-ischemic encephalopathy and the associated patterns of cerebral injury in the context of the most probable timing of the insult and prognosis. The evolution of the clinical features of significant hypoxic-ischemic encephalopathy, and the diagnostic value of imaging and electrophysiologic and metabolic studies are discussed. Current approaches to management are outlined.
Evolution of periventricular leukomalacia during the neonatal period and infancy: correlation of imaging and postmortem findings
1988, Early Human Development
Eighteen of 68 infants born over a 4-year period who had cranial ultrasound studies and later came to necropsy were found to have periventricular leukomalacia (PVL). Thirteen were diagnosed in life and there was one false positive diagnosis giving an accuracy of 91%, sensitivity of 72% and specificity of 98%. In 11 infants with sequential studies, who died at ages from 43 h to 3 years, the ultrasound findings were correlated with those at postmortem to establish the natural history of the condition. In infants who died within 7 days following the onset of the ultrasound changes, postmortem revealed early PVL without cysts: there were small haemorrhages into the affected areas in three of the four cases. In the five infants who died between 10 days and 9 weeks, cystic lesions were identified in life and at postmortem, but in two long-term survivors cysts resolved on ultrasound at 3–4 months of age. Correlation of ultrasound with postmortem findings demonstrated that, although the ultrasound lesions resolve, glial scarring and impaired myelination can still be demonstrated on careful pathological examination.
PREDICTIVE VALUE OF CRANIAL ULTRASOUND IN THE NEWBORN BABY: A REAPPRAISAL
1985, The Lancet
During a 36-month period 435 babies of 34 weeks' gestation or less were regularly scanned with ultrasound. A large periventricular/intraventricular haemorrhage developed in 40 babies, and extensive cystic leucomalacia developed in 10. The neurodevelopmental outcome and the frequency of handicap in these 2 groups were compared. 9 of the 18 survivors with a large haemorrhage were found to be completely normal and only 2 showed a major handicap. However, severe cerebral palsy with mental retardation developed in all the survivors with extensive cystic leucomalacia, and 4 of the 7 babies were also cortically blind. These findings suggest that the size of the haemorrhage is not a good predictor of outcome, but that severe cystic leucomalacia is associated with a very poor prognosis.
Neurodevelopmental outcome at 12 months of age related to cerebral ultrasound appearances of high risk preterm infants
1985, Early Human Development
A prospective neurological and developmental assessment at 12 months of age corrected for prematurity was performed on 54 surviving preterm infants of 34 weeks' gestation or less. The babies were allocated into three groups according to their ultrasound (US) appearances: Group I (n = 29), normal scan; Group II (n = 10), isolated periventricular-intraventricular haemorrhage (PVH); Group III (n = 15), association of PVH, periventricular leukomalacia (PVL) and ventricular dilatation. The developmental outcome evaluated with the Griffiths' development quotient (DQ) was good and similar in Groups I and II, while it was worse and variable in Group III. There was also a higher incidence of neurological abnormalities in Group III, as 47% of children only were found to be normal compared to 86% and 80% in Groups I and II, respectively. A major handicap was diagnosed in 5 children of Group III. Infants with small lesions of PVH or PVL or with ventricular dilatation developed as well as children with normal US scan, whereas more diffuse or extensive US changes of PVL had a poorer prognosis. The outcome of a cerebral injury seems to depend on the type, the size and localisation of the lesion, and to some extent, on the neuroplasticity of the developing brain.
Neonatal cerebral pathology diagnosed by ultrasound
1985, Clinics in Perinatology
This article discusses cranial ultrasonography in various clinical settings. Since 1979, the authors have screened all preterm infants for intracranial hemorrhage, and here they present their experience with hemorrhage and its sequel, ventricular dilatation. Also discussed is the use of cranial ultrasonography in infants with seizures and encephalopathy and in infants with abnormal head growth or suspected cerebral malformations.

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Diagnosis and evolution of periventricular leukomalacia: a study with real-time ultrasound

Abstract

Periventricular leucomalacia in neonates

Pathogenesis and evolution of periventricular leukomalacia in infancy

Arch. Neurol.