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Periventricular leukomalacia in infancy: ultrasonic diagnosis and neurological outcome
1Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Insights
Cystic periventricular leukomalacia (PVL) in infants, diagnosed via cranial ultrasonography, often leads to severe motor dysfunction. Early detection and screening of high-risk infants are crucial for better outcomes.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Developmental Pediatrics
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological impairment in infants.
- Cystic PVL, a severe form, requires accurate diagnosis and prognostic evaluation.
- Cranial ultrasonography is a key tool for identifying PVL in neonates.
Purpose of the Study:
- To describe the sonographic findings and clinical outcomes of infants diagnosed with cystic periventricular leukomalacia (PVL).
- To evaluate the prognostic value of PVL in relation to perinatal insults and neurodevelopmental outcomes.
Main Methods:
- Retrospective analysis of 24 infants diagnosed with cystic PVL via cranial ultrasonography between January 1984 and June 1989.
- Longitudinal sonographic follow-up for Group A (n=6) to observe PVL development.
- Clinical assessment of neurodevelopmental status for Group B (n=18) presenting with psychomotor retardation.
Main Results:
- Cystic PVL development showed a progression from high echogenicity (2-7 days) to cystic formations (18-60 days).
- Group A: 5/6 premature infants with perinatal insults experienced abnormal motor development.
- Group B: 18 infants showed high rates of cerebral palsy, including spastic quadriplegia, hemiplegia, and dysplegia.
Conclusions:
- Cystic PVL is a strong predictor of poor neurodevelopmental outcomes in infants.
- Cranial ultrasonography is effective in diagnosing and monitoring PVL.
- Physicians must screen high-risk infants, particularly those with perinatal insults, for PVL.
Abstract:
During the more than five years from January 1984 to June 1989, twenty-four patients with definite or probable cystic periventricular leukomalacia (PVL) were diagnosed by cranial ultrasonography at Mackay Memorial Hospital. The 24 patients were divided into two groups. Group A comprise two boys and four girls who received longitudinal sonographic follow-ups for leukomalacia. Of these six patients, five were premature and all suffered from severe perinatal insults. In each case, sequences of developmental cystic PVL were observed by serially scanning the brain. High echogenicity was discovered during the initial stages (2 to 7 days) in the periventricular area, and cystic formations were observed between the age of 18 and 60 days. Clinically, only one patient developed normally; four had severe motor dysfunction and poor motor development; and one was lost during follow-up, Group B was composed of 18 patients who visited the out-patient clinic for psychomotor retardation evaluation, and were found through ultrasound to have or possibly have cystic PVL formations at various stages. The clinical work-up revealed that 12 had spastic quadriplegia; 2 had hemiplegia; 3 had spastic displegia; and 1 case had hypotonic cerebral palsy. In infants, PVL is considered to be a much more reliable and important prognostic predictor than intraventricular hemorrhage. Consequently, it is crucial that physicians should screen patients at high risk for PVL, especially those with perinatal insults.