What is PVL?
In short, PVL is a softening of the white matter tissue of the brain. It is a type of brain injury that occurs in babies usually during the time of pregnancy. In particular, it is a softening of the periventricular white matter of the brain. This area of the brain transmits the nerve impulses that control motor function. With PVL, cells in this area decay & die, leaving empty voids or holes in the brain. These holes then fill up with fluid, which results in the condition known as PVL. The damage caused by PVL affects motor movements and usually causes a tightness in the muscles. Infants with PVL have an increased risk for cerebral palsy, which is a condition which causes problems with muscle control. They are also at risk for developmental and cognitive issues.
What are the symptoms of PVL?
It can be difficult to detect in new-born infants. In some cases, there are no immediate symptoms and the injury may not become apparent until the infant is a couple of months old. The symptoms are unique to each individual child.
Symptoms include:
- Issues with motor movement
- Poor co-ordination
- Vision & eye movement problems
- Developmental delay that becomes increasingly apparent over time
- Intellectual impairment
- Hearing impairment
- Epilepsy
- Spastic diplegia (a form of cerebral palsy that causes tight, contracted muscles, mostly in the legs)
- Spastic quadriplegia (a form of cerebral palsy that causes tight, contracted muscles in all 4 limbs)
How is PVL diagnosed?
A PVL injury is diagnosed with the use of radiographic imaging (including a cranial ultrasound and CT or MRI scan). It can be difficult to see the changes caused by PVL in the brain when the infant is very young. Infants with known risk factors for PVL may receive an MRI earlier on, however, the changes may not be apparent on the imaging until the child reaches the age of 2 years old (this is when the brain myelination is complete).
How is PVL treated?
Infants who are diagnosed with PVL, or who at risk for PVL, require special care after hospital discharge. As discussed, the imaging may not detect a PVL injury early on, so regular developmental assessments should be performed if PVL is suspected.
Unfortunately, there is no medical treatment to cure PVL. The damaged area of the brain will not regenerate. However, there is a wide range of rehabilitative therapies available that can help manage the condition and also limit its long term effects and symptoms. These therapies can include:
- Physiotherapy
- Occupational therapy
- Speech & language therapy
- Massage therapy
- Behavioural therapy
- Play therapy
- Orthotic input &
- Specialist educational input
PVL is not a progressive condition so the injury does not gradually worsen as the infant gets older (i.e. the damage to the white matter does not continue to expand after birth). Although it is not a progressive condition, the physical symptoms usually become more apparent as the child grows. Ongoing and continuous rehabilitative input will certainly help to limit the long term effects of the injury.
Cause of PVL
The exact cause of PVL is unknown, however, it is reported that a decreased flow of oxygenated blood or cell damage to the periventricular tissue is the primary cause of PVL.
The periventricular white matter is an area of the brain is very prone to injury, especially in a foetus between 22 & 33 weeks gestation. At this stage, the baby’s brain is especially vulnerable to the effects of hypoxia, blood flow issues & inflammation. These things affect the cell line, which is largely populated in this white matter area, and this can cause PVL.
Infections of the foetal membranes and other types of maternal infection are a common source of an interruption to the blood and oxygen flow. The foetal membranes are affected by the release of toxins, which travel through amniotic fluid to selectively injure areas of the developing brain. These toxins can also cause a premature rupture of the membranes and premature birth.
Bleeding inside the brain (intrapartum haemorrhage) can also cause an interruption of the blood supply to this part of the brain.
There are some risk factors for PVL:
- An infant born before 32 weeks’ & who was mechanically ventilated
- Maternal infection around the time of delivery
- An infection of the amniotic fluid
- Untreated maternal UTI
- Placental blood vessel conditions
- A twin pregnancy
- Vaginal bleeding during pregnancy
- Intraventricular haemorrhage (bleeding inside the brain)
- An inflammation of the umbilical cord connective tissue
- Sepsis
- Maternal cocaine use
How is PVL prevented?
The following actions can help prevent the development of PVL:
- Reducing the risk of prematurity
- Preventing lack of oxygen/blood flow to the baby’s brain
- Reducing blood pressure swings and hypotension
- Reducing the risk of maternal intrauterine infections
Can PVL be caused by medical negligence?
PVL may have been caused by medical negligence.
It must be proved that there was a breach of the duty of care owed by the medical practitioner. And that this breach caused the PVL.
If you suspect that your child’s PVL injury could have been prevented, then it is advisable to contact a solicitor to get further advice
Specialist birth injury solicitors
We at McMahon Goldrick Solicitors, specialise in acting on behalf of children who have sustained birth injuries caused by medical negligence.
We are the only firm in Ireland to exclusively specialise in representing clients who have sustained birth, brain & spinal injuries.
Due to the small & specialist nature of our firm, we have the ability to spend the necessary time to do a thorough examination of the medical records in a potential new birth injury matter and we continuously educate ourselves on the new & emerging recommended best obstetric & neonatal care practices
If you would like any further information on PVL, or have an enquiry in relation to a possible birth injury matter, please feel free to call or email us any time.
