Neonatal periventricular leukomalacia: diagnosis and evolution evaluated by real-time ultrasound

Recent advances in imaging techniques have provided the opportunity to obtain prompt diagnosis and to study the natural evolution of periventricular leukomalacia (PVL). Three premature neonates were followed up by brain sonograms from birth to six, four and three months of age, respectively. Sequential ultrasound examinations confirmed previous observations which identified four stages of PVL; 1. increased echogenicity in the periventricular white matter, 2. apparent normalization, 3. cystic cavitation, 4. resolution of cysts and development of ventriculomegaly. Decreased perfusion of the periventricular end-arterial zone is responsible for the development of PVL; this selective hypoperfusion has been documented in infants with a significant history of cardiorespiratory disturbances and group-B streptococcal sepsis. Two of our patients and other cases described in the literature, however, did not exhibit these clinical features. The present study suggests the involvement of chronic hypoxia and toxic insults in the pathogenesis of this condition and confirms the value and accuracy of sequential sonography in the diagnosis of PVL.