- is the most common ishaemic brain injury of neonates.
- the prognosis is poor. many surviving infants will have cerebral palsy.
- occurs when there is a loss of arterial flow at the watershed point in the peri-ventricular white matter.
begins with increased echogenicity of the parenchyma superior to the lateral ventricles (=/> choroid plexus). the increased echogenicity corresponds with inflammation. if ischaemia ensues. this will become more echogenic and subsequently degenerate into small cystic areas.
grading of pvl
- grade l – periventricular flares more than 1 week old
- grade il – small periventricular cysts
- grade ill – defined as extensive periventricular cysts
- grade lv – multicystic leukomalacia in the periventricular and subcortical region
ref:de vries ls, eken p, dubowitz lm. “the spectrum of leukomalacia using cranial ultrasound.” behav brain res. jul 31 1992;49(1):1-6.
mri is usually required to provide longer term follow-up and prognostics.