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Neurology India 2010
Review
Topics: Biopsy; Brain; Humans; Infant, Newborn; Leukomalacia, Periventricular; Male; Mycoses
PubMed: 21150068
DOI: 10.4103/0028-3886.73757 -
Obstetrics and Gynecology Nov 2009To estimate whether there are placental histopathologic abnormalities associated with neonatal periventricular leukomalacia (PVL), a major precursor of cerebral palsy.
OBJECTIVE
To estimate whether there are placental histopathologic abnormalities associated with neonatal periventricular leukomalacia (PVL), a major precursor of cerebral palsy.
METHODS
This is a case-control study of 167 neonates born between 23 and 34 weeks of gestation diagnosed with PVL by head ultrasonography within 6 weeks of birth, and 167 control neonates without neurologic morbidity matched by gestational age. Placentas for both case neonates and control neonates were reviewed by two perinatal pathologists who were blinded to neonatal course.
RESULTS
Neonates with PVL were significantly more likely to have positive neonatal blood (28.7%, 16.8%, P=.001) and cerebrospinal fluid (14.4%, 4.8%, P=.007) cultures. The ratio of placental weight to birth weight did not differ between groups, but neonates with PVL had significantly more chronic diffuse capsular deciduitis (20.4%, 10.8%, P=.02) and capsular decidual plasma cells (8.4%, 2.4%, P=.02). Conditional logistic regression adjusting for birth weight and the presence of multiple gestation in the identification of PVL showed a significant increase for diffuse capsular deciduitis (P=.02) and capsular decidual plasma cells (P=.03).
CONCLUSION
Periventricular leukomalacia has a significant but weak association with chronic diffuse capsular deciduitis and the presence of capsular decidual plasma cells, evidence of chronic infection but not histologic acute chorioamnionitis.
LEVEL OF EVIDENCE
II.
Topics: Birth Weight; Case-Control Studies; Decidua; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Inflammation; Leukomalacia, Periventricular; Organ Size; Placenta; Plasma Cells; Pregnancy; Ultrasonography
PubMed: 20168115
DOI: 10.1097/AOG.0b013e3181bdcfc4 -
Journal of Child Neurology May 2023To assess the diagnostic value of the thalamus L-sign on magnetic resonance imaging (MRI) in distinguishing between periventricular leukomalacia and neurometabolic... (Comparative Study)
Comparative Study
PURPOSE
To assess the diagnostic value of the thalamus L-sign on magnetic resonance imaging (MRI) in distinguishing between periventricular leukomalacia and neurometabolic disorders in pediatric patients.
METHODS
In this retrospective study, clinical and imaging information was collected from 50 children with periventricular leukomalacia and 52 children with neurometabolic disorders. MRI was used to evaluate the L-sign of the thalamus (ie, injury to the posterolateral thalamus) and the lobar distribution of signal intensity changes. Age, sex, gestational age, and level of Gross Motor Function Classification System (only for periventricular leukomalacia) constituted the clinical parameters. Statistical evaluation of group differences for imaging and clinical variables were conducted using univariable statistical methods. The intra- and inter-observer agreement was evaluated using Cohen's kappa. Univariable or multivariable logistic regression was employed for selection of variables, determining independent predictors, and modeling.
RESULTS
The thalamus L-sign was observed in 70% (35/50) of patients in the periventricular leukomalacia group, but in none of the patients with neurometabolic disorder ( < .001). The gestational age between groups varied significantly ( < .001). Involvement of frontal, parietal, and occipital lobes differed significantly between groups ( < .001). In the logistic regression, the best model included negative thalamus L-sign and gestational age, yielding an area under the curve, accuracy, sensitivity, specificity, and precision values of 0.995, 96.1%, 96%, 96.2%, and 96%, respectively. Both the lack of thalamus L-sign and gestational age were independent predictors ( < .001).
CONCLUSIONS
The thalamus L-sign and gestational age may be useful in distinguishing between periventricular leukomalacia and neurometabolic disorders.
Topics: Child; Humans; Brain Diseases, Metabolic; Diagnosis, Differential; Frontal Lobe; Gestational Age; Infant, Premature; Leukomalacia, Periventricular; Logistic Models; Magnetic Resonance Imaging; Occipital Lobe; Parietal Lobe; Retrospective Studies; Thalamus; Biomarkers; Motor Skills; Male; Female; Infant; Child, Preschool; Adolescent
PubMed: 37128731
DOI: 10.1177/08830738231168973 -
No To Shinkei = Brain and Nerve Jul 2000
Review
Topics: Axons; Brain Ischemia; Cerebral Palsy; Excitatory Amino Acids; Humans; Infant, Newborn; Leukomalacia, Periventricular; Neuronal Plasticity; Oligodendroglia
PubMed: 10934719
DOI: No ID Found -
Archives de Pediatrie : Organe Officiel... Jun 2005
Review
Topics: Animals; Fetal Diseases; Humans; Infant, Newborn; Inflammation; Leukomalacia, Periventricular; Syndrome
PubMed: 15904788
DOI: 10.1016/j.arcped.2005.03.018 -
Seminars in Perinatology Apr 2006Historically the major focus in neonatal neurology has been on brain injury in premature infants born less than 30 gestational weeks. This focus reflects the urgent need... (Review)
Review
Historically the major focus in neonatal neurology has been on brain injury in premature infants born less than 30 gestational weeks. This focus reflects the urgent need to improve the widely recognized poor neurological outcomes that occur in these infants. The most common underlying substrate of cerebral palsy in these premature infants is periventricular leukomalacia (PVL). Nevertheless, PVL also occurs in near-term (late preterm), as well as term, infants, as documented by neuroimaging and autopsy studies. In both very preterm and late preterm infants, gray matter injury is associated with PVL. In this review, we discuss the cellular pathology of PVL and the developmental parameters in oligodendrocytes and neurons that put the late preterm brain at risk in the broader context of brain development and injury close to term. Further research is needed about the clinical and pathologic aspects of brain injury in general and PVL in particular in late preterm infants to optimize management and prevent adverse neurological outcomes in these infants that, however subtle, may be currently underestimated.
Topics: Antioxidants; Axons; Brain; Enzymes; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Pregnancy
PubMed: 16731282
DOI: 10.1053/j.semperi.2006.02.006 -
Journal of Child Neurology Apr 2016This study investigates the developmental outcomes of preterm children according to severity of periventricular leukomalacia. One hundred preterm children with...
This study investigates the developmental outcomes of preterm children according to severity of periventricular leukomalacia. One hundred preterm children with periventricular leukomalacia evident on brain magnetic resonance imaging and who had undergone neuropsychologic evaluation were selected. Intellectual disability was noted in 27.8% of the children with mild periventricular leukomalacia, 53.2% with moderate periventricular leukomalacia, and 77.1% with severe periventricular leukomalacia. The rates of major neurodevelopmental impairments such as cerebral palsy or intellectual disability were related to the severity of periventricular leukomalacia but not to gestational age or epilepsy. There were significant differences in the intelligence quotient (IQ) and social maturity quotient between 3 groups of periventricular leukomalacia. The performance IQ was significantly lower than the verbal IQ. Behavioral problems were noted in about one-third of the children but the rate was not related with the severity of periventricular leukomalacia. Our study revealed the significant associations between severity of periventricular leukomalacia and cognitive and social adaptive functions in the preterm children.
Topics: Adolescent; Adult; Brain; Child; Child Behavior; Cognition Disorders; Developmental Disabilities; Epilepsy; Female; Gestational Age; Humans; Image Processing, Computer-Assisted; Leukomalacia, Periventricular; Logistic Models; Magnetic Resonance Imaging; Male; Neurologic Examination; Neuropsychological Tests; Outcome Assessment, Health Care; Premature Birth; Social Behavior; Young Adult
PubMed: 26385973
DOI: 10.1177/0883073815604229 -
The Journal of Thoracic and... Mar 2004Periventricular leukomalacia is necrosis of the cerebral white matter adjacent to the lateral ventricles and results from injury to immature oligodendroglia. In infants...
OBJECTIVES
Periventricular leukomalacia is necrosis of the cerebral white matter adjacent to the lateral ventricles and results from injury to immature oligodendroglia. In infants without congenital heart disease, periventricular leukomalacia is associated with an increased incidence of developmental delay and attention deficit/hyperactivity disorder. The incidence of periventricular leukomalacia and the risk factors for development of periventricular leukomalacia after infant cardiac surgery are not known.
METHODS
Magnetic resonance imaging of the brain was performed 6 to 14 days after cardiac surgery utilizing cardiopulmonary bypass with or without deep hypothermic circulatory arrest in 105 neonates and infants < or = 6 months of age.
RESULTS
Median age at surgery was 6 days (range 1-178), with 82 neonates (age < or = 30 days). Periventricular leukomalacia was found in 44 of the neonates (54%) compared with 1 of 23 infants (4%). Forward logistic regression using age at surgery as a continuous variable identified a model containing longer total support time (cardiopulmonary bypass plus deep hypothermic circulatory arrest), lower systolic blood pressure at cardiac intensive care unit admission postoperatively, lower minimum diastolic blood pressure, and Po(2) in the first 48 hours after surgery. When age at surgery was considered as a dichotomous variable (neonate versus infant), younger age at surgery replaced systolic blood pressure, Po(2), and total support time in the model. Lower minimum diastolic blood pressure was a significant risk factor in both models.
CONCLUSIONS
Periventricular leukomalacia was found in >50% of neonates after cardiac surgery but rarely in older infants. Hypoxemia and hypotension in the early postoperative period, particularly diastolic hypotension, may be important risk factors for periventricular leukomalacia.
Topics: Apolipoproteins E; Blood Pressure; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Female; Genotype; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Leukomalacia, Periventricular; Logistic Models; Magnetic Resonance Imaging; Male; Oxygen; Risk Factors
PubMed: 15001897
DOI: 10.1016/j.jtcvs.2003.09.053 -
The Journal of Veterinary Medical... Aug 2016A 10-day-old, Japanese Black, female calf had shown astasia since just after birth. Focal symmetrical periventricular malacic lesions of the cerebrum and suppurative...
A 10-day-old, Japanese Black, female calf had shown astasia since just after birth. Focal symmetrical periventricular malacic lesions of the cerebrum and suppurative arthritis of the left hip joint were observed in macroscopic examination. Histologically, the cerebral lesions were confirmed as periventricular leukomalacia (PVL). The location and histological features of the lesions were similar to PVL in humans, caused by neonatal ischemia/hypovolemia. This is the first report of PVL in a neonatal calf.
Topics: Animals; Animals, Newborn; Cattle; Cattle Diseases; Female; Leukomalacia, Periventricular
PubMed: 27010465
DOI: 10.1292/jvms.16-0034 -
American Journal of Ophthalmology Aug 2022To determine whether rates of strabismus and associated visuomotor deficits differed among children with different severities of periventricular leukomalacia (PVL).
PURPOSE
To determine whether rates of strabismus and associated visuomotor deficits differed among children with different severities of periventricular leukomalacia (PVL).
DESIGN
Retrospective, case-control study.
METHODS
Brain magnetic resonance images (MRI) obtained from 98 children aged ≥2 years were analyzed using a standardized scoring system: 67 of 98 had PVL (mean GA 31 weeks) and 31 of 98 did not have PVL (mean GA 29 weeks). Severity of PVL was scored as degree of damage to the posterior optic radiations and the splenium of the corpus callosum on MRI. Ophthalmologic examination data were collated to assess the prevalence of visuomotor deficits and the relationship to PVL severity (grades 1-3, mild to severe).
RESULTS
Infantile strabismus was documented in 61% of children with mild, 74% with moderate, and 88% with severe PVL (esotropia: exotropia ratio 3.5:1). Associated ocular motor deficits also increased systematically with PVL severity: latent ("fusion maldevelopment") nystagmus (20%, 47%, and 40%, respectively), dissociated vertical deviation (13%, 28%, and 30%), and nasotemporal pursuit/optokinetic nystagmus asymmetry (23%, 38%, and 54%). Additionally, the prevalence of retrograde optic neuropathy increased with PVL severity (5%, 26%, and 38%). The prevalence of each of these signs was substantially lower in children who had no PVL.
CONCLUSIONS
Children who suffer PVL are likely to develop the deficits of the infantile strabismus complex. The deficits tend to increase systematically as a function of PVL severity. These findings provide evidence that infantile strabismus is linked to perinatal damage to cerebral vergence and gaze pathways.
Topics: Case-Control Studies; Child; Humans; Infant, Newborn; Leukomalacia, Periventricular; Magnetic Resonance Imaging; Nystagmus, Pathologic; Prevalence; Retrospective Studies; Strabismus
PubMed: 35381203
DOI: 10.1016/j.ajo.2022.03.028