Periventricular Leukomalacia (PVL or PVLM) is an ischaemic brain injury typically seen in preterm infants as part of cranial ultrasound screening. The exact aetiology is postulated to be multifactorial, with factors such as a particularly vulnerable vascular network, poor cerebral vascular autoregulation, the vulnerability of premature newborn infant white matter, and intrauterine infection or inflammation.
Cystic lesions are typically not present within the first week, although often in the first week there is some hyperechogenicity of periventricular white matter. In many infants, this resolves without subsequent development of cystic PVLM. However, in some infants cystic change develops over the ensuing weeks. Cystic changes tend to be lateral and superior to the lateral ventricles, usually involving the parietal regions and extending posteriorly. This is in contrast to the extent and position of isolated frontal horn cysts (which are not associated with significant long-term problems).
Neurodevelopmentally, there is a high risk of subsequent impairment in survivors. Prognosis depends on how extensive the lesions are, as well as location.
The images to the right are from an infant born at 30 weeks. He had a relatively stable immediate neonatal course and head scans were performed as part of his routine care.