Periventricular leucomalacia

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Classification according to ICD-10
P91.2 Cerebral leucomalacia in the newborn
ICD-10 online (WHO version 2019)

Under a periventricular leucomalacia ( PVL ) ( ancient Greek περί perí , German 'around, around' , Latin ventriculus 'small belly, stomach' and ancient Greek λευκός leukós , German 'white' and μαλακός malakós , German 'soft, tender' ) in the Medicine understood one of the most common white matter damage in the brain caused by significant lack of oxygen . The PVL is especially common in premature children in infancy on.

The term comes from Banker & Larroche in 1962.

frequency

Periventricular leucomalacia can be diagnosed in around 5 out of 100 newborns with a birth weight of less than 1.5 kg.

root cause

In periventricular leucomalacia it is caused by a lack of oxygen, such as that caused by e.g. B. occurs in respiratory disorders or insufficient blood flow, death of brain cells in the dorsal and lateral area of ​​the side ventricles (= periventricular ) come (in the so-called germinative matrix ). The lesion causes a softening ( malacia ) of the white matter. The damage can already have arisen prenatally as a complication of FIRS (fetal inflammatory response syndrome).

Effects

In the white matter there are motor nerve fibers that allow voluntary movements . Due to the damage in this area from periventricular leucomalacia, cysts develop in the sensitive brain regions; first in the white matter, later also in the lateral cerebral ventricles. As a result, the children experience failures of motor functions of varying severity , which depend on the extent of the changes. The movement disorders often affect the legs ( diplegia ) and sometimes the arms ; spasticity occurs . Impairments to cognitive functions are also possible in the event of severe damage. Epilepsy (e.g. West syndrome ) can develop .

diagnosis

In younger children, periventricular leucomalacia can be diagnosed by ultrasound ; in older children (approx. From the age of 24 months) magnetic resonance imaging ( MRI ) is the diagnostic method of choice.

Several stages can be distinguished sonographically :

  • Necrosis of the white matter lateral to the lateral ventricles, acute phase, sonographically increased echogenicity
  • cystic transformation, chronic phase, sonographic detection of cysts
  • Residual stage with / without circumscribed ventricular deformation and / or enlargement, normalized echogenicity.

A PVL can be circumscribed as a focal region with increased echogenicity, in which case a periventricular hemorrhage must be defined; or as a more diffuse increase in echogenicity periventricular. In the initial stage, the differentiation from the normal echogenicity increase "physiological immaturity" is difficult or even impossible.

Several days pass between damage and sonographically recognizable increase in echogenicity; It is not uncommon for there to be a period of time between the acute and chronic phase without any noticeable abnormalities (silent phase). The diagnosis is often not made until 4–6 weeks after the damage, through the detection of sonographically clearly demarcated cysts in the periventricular white matter.

In the MRI, there are speckled signal increases in the white matter adjacent to the ventricle, as well as narrowing in the bar corresponding to the tissue damage.

A prognosis for the development of the child is difficult or impossible due to the interpretation of the picture; the actual individual development of a child cannot be predicted.

treatment

The effects in the area of ​​motor skills can be treated with physiotherapy . Another method of treatment is conductive support according to Petö . It is a complex method in which pedagogical and medical knowledge is combined with physiotherapy, occupational therapy, speech therapy and other elements, depending on the individual needs. The aim of conductive support is to achieve the greatest possible independence from aids through the acquisition of everyday processes.

literature

Web links

Individual evidence

  1. ↑ BQ BANKER, JC Larroche: periventricular leukomalacia of infancy. A form of neonatal anoxic encephalopathy. In: Archives of Neurology . Volume 7, November 1962, pp. 386-410, ISSN  0003-9942 . PMID 13966380
  2. ↑ Medrapid, Periventricular Leukomalacia of Premature Babies (PVL) Stage 1 ( Memento of the original from January 7, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.medrapid.info
  3. ↑ a b E. G. Grant, D. Schellinger u. a .: Echogenic periventricular halo: normal sonographic finding or neonatal cerebral hemorrhage. In: American Journal of Roentgenology . Volume 140, Number 4, April 1983, pp. 793-796, ISSN  0361-803X . doi: 10.2214 / ajr.140.4.793 . PMID 6601391 .