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Periventricular leukomalacia (PVL) is usually described as a disorder of the developing white matter in premature babies. PVL is a brain injury that is characterized by significantly reduced blood flow in the white matter of the brain, next to the lateral ventricles. Peri means “near,” ventricular refers to the ventricles in the brain, and leukomalacia refers to softening of the brain’s white matter. Leukomalacia occurs when brain tissue dies.
PVL can be caused by this sequence of events:
- An event or condition causes decreased oxygen and blood flow to the periventricular region of the brain;
- The decreased oxygen / blood flow causes damage to the cells that make up much of the white matter in the brain.
- In addition, intrauterine infection, which is a common pregnancy condition, increases the incidence of PVL and cerebral palsy by raising levels of inflammatory cytokines, such as interferon-gamma, in the brain of the fetus. Cytokines are signaling proteins that help cells communicate with each other.
Indeed, babies who have been diagnosed with PVL are often later diagnosed with cerebral palsy. This is because cerebral palsy occurs when there is damage to the parts of the brain that control motor function, and these regions of the brain, in large part, are near the ventricles. Periventricular white matter is white brain matter that is immediately to the side of the two side ventricles of the brain. As mentioned, white matter is very important for muscle movement.
The Result of Periventricular White Matter Damage
When a doctor says that there have been periventricular white matter changes, or that there is periventricular white matter damage, it means that there have been changes in the structure of the white matter near the ventricles of the brain. In premature babies who have experienced oxygen deprivation during or near the time of birth, the most common area damaged is the periventricular white matter – usually near the collateral trigone, which is a triangle-shaped prominence on the floor of the lateral ventricle.
Damage to this area typically results in the premature baby being diagnosed with moderate to severe cerebral palsy that is classified as either spastic diplegia or spastic quadriplegia, with the legs more involved than the upper extremities. Mild to severe intellectual disability may occur, but many children with spastic cerebral palsy have a normal or above normal level of intelligence.
What Are the Causes of Oxygen Deprivation and Intrauterine Infection?
Both oxygen deprivation and intrauterine infection are common causes for periventricular leukomalacia, and it’s often possible for vigilant physicians to prevent both outcomes during the birthing process.
Here are some of the most common causes for oxygen deprivation during birth:
- Nuchal cord (umbilical cord wrapped around baby’s neck)
- True knot in umbilical cord
- Umbilical cord prolapse (when the cord descends the birth canal before or alongside the baby)
- Short umbilical cord
- Vasa previa (umbilical cord blood vessels migrate out of the protective amniotic sac membranes, where they are at high risk of rupturing if the baby is delivered vaginally)
- Preeclampsia
- Placental abruption
- Placental previa
- Placenta accreta
- Placental insufficiency
- Uterine rupture
- Trauma to the baby’s head during delivery, which can cause a brain bleed
- Severely low blood pressure in the mother, which can be caused by anesthesia and blood loss
Causes and risk factors for intrauterine infection include:
- Urinary tract infection (UTI)
- Bacterial vaginosis (BV)
- Group B strep (GBS)
- Premature rupture of the membranes (PROM)
- Premature labor
- Prolonged labor
- Short cervix
- Obesity during pregnancy
- Internal monitoring of labor
- Multiple vaginal exams
Our Medical Malpractice Attorneys Are Here to Help
If your baby was born prematurely and was diagnosed with periventricular leukomalacia (PVL), or if you think your baby experienced a traumatic birth, oxygen deprivation, a brain bleed, delayed delivery, or delayed emergency C-section, please contact our team of experienced birth injury attorneys. The medical malpractice team at Grewal Law PLLC is comprised of attorneys and healthcare professionals, including an on-site registered nurse, pharmacist, paramedic, and respiratory therapist. We also work with the best consultants from around the country, as well as an on-site physician. Our attorneys are licensed in Michigan and Florida, and we help victims of medical malpractice and birth trauma throughout these states.
If your baby was diagnosed with HIE, seizures, cerebral palsy, motor disorders, periventricular leukomalacia (PVL), hydrocephalus, intellectual disabilities, or developmental delays, or if you experienced problems during delivery or shortly before or after birth – or in the NICU – please call us.
Call (888) 211-5798 today to speak with our seasoned medical malpractice attorneys and medical staff. We’re available 24/7!