Jacques L. De Reuck, MD; Henri M. Vander Eecken, MD. After clearing, choose preferred Journal and select login for AAN Members. [22], Other ongoing clinical studies are aimed at the prevention and treatment of PVL: clinical trials testing neuroprotectants, prevention of premature births, and examining potential medications for the attenuation of white matter damage are all currently supported by NIH funding. As has been discussed, this condition is often mistaken for normal tension glaucoma. . Treatment is symptomatic and supportive. Table 3 lists the findings on OCT that help to differentiate glaucomatous from pseudo-glaucomatous cupping in PVL. Learn about clinical trials currently looking for people with PVL at Clinicaltrials.gov. Haynes RL, Folkerth RD, Keefe RJ, Sung I, Swzeda LI, Rosenberg PA, Volpe JJ, Kinney HC. The most common PVL symptoms appear by six to nine months of age and may include: Your healthcare provider will ask about your childs symptoms and health history. Pathologic changes consisted of infarction and demyelination of periventricular white matter, with associated necrotic foci in the basal ganglia in some cases. Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children. An emphasis on prenatal health and regular medical examinations of the mother can also notably decrease the risk of PVL. But you can help improve your childs quality of life by seeking treatment as soon as symptoms appear. There is no specific treatment for PVL. Periventricular leukomalacia (PVL) is characterized by the death or damage and softening of the white matter, the inner part of the brain that transmits information between the nerve cells and the spinal cord, as well as from one part of the brain to another. Liu, Volpe, and Galettas Neuro-Ophthalmology (Third Edition). One of the methods used for grading periventricular leukomalacia on sonographic appearance is as follows: grade 1: areas of increased periventricular echogenicity without any cyst formation persisting for more than 7 days. Occasionally, physicians can make the initial observations of extreme stiffness or poor ability to suckle. Table 2: Comparison of characteristic clinical features of normal tension glaucoma and PVL. 2021 Aug 23;12:714090. doi: 10.3389/fimmu.2021.714090. These symptoms include problems controlling movement, developmental delays, learning disabilities and seizures. The percentage of individuals with PVL who develop cerebral . Periventricular leukomalacia is caused by insufficient oxygen in the baby (hypoxemia and hypoxia) and/or restricted or decreased blood flow in the brain (ischemia). Early water breaking or bursting of your membranes (amniotic sac). Accessibility PVL may occur when not enough blood or oxygen gets to your childs brain. It is a brain injury characterized by necrosis or coagulation of white matter near the lateral ventricles. Pathophysiology of periventricular leukomalacia: What we learned from animal models. Leuko means white. The periventricular area-the area around the spaces in the brain called ventricles-contains nerve fibers that carry messages from the brain to the body's muscles. Ganesh S, Khurana R, Wallang B, Sharma S. Ophthalmic Manifestations in Children with Periventricular Leukomalacia. A rat model that has white matter lesions and experiences seizures has been developed, as well as other rodents used in the study of PVL. Periventricular leukomalacia in adults. The percentage of individuals with PVL who develop cerebral palsy is generally reported with significant variability from study to study, with estimates ranging from 20% to more than 60%. Bookshelf Focal PLV consists of localized cell necrosis in periventricular white matter. Page highlights. Severe cases of PVL can cause cerebral palsy. Therefore, it is essential to raise awareness of PVL as a possible cause of strabismus, visual deficit and cupping in patients with history of prematurity and perinatal complication. About 7,000 of these children develop cerebral palsy. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). . Note that perinatal postgeniculate injury such as PVL may produce optic atrophy via trans-synaptic degeneration. Clinical trials are studies that allow us to learn more about disorders and improve care. Haynes RL, Baud O, Li J, Kinney HC, Volpe JJ, et al. . There is no specific treatment for PVL. [15], Current clinical research ranges from studies aimed at understanding the progression and pathology of PVL to developing protocols for the prevention of PVL development. These are the two primary reasons why this condition occurs. Periventricular leukomalacia (a.k.a white matter injury of prematurity) is injury to the white matter surrounding the ventricles due to a variety of perinatal brain insults affecting preterm babies. Chapter: 760-779. Periventricular leukomalacia (PVL) is a softening of white brain tissue near the ventricles. Am J Neuroradiol. Damage to the white matter results in the death and decay of injured cells, leaving empty areas in the brain called lateral ventricles, which fill with fluid (a . The term can be misleading, because there is no softening of the tissue in PVL. Approximately 60-100% of children with periventricular leukomalacia are diagnosed with Cerebral Palsy. If you are responding to a comment that was written about an article you originally authored: (For instructions by browser, please click the instruction pages below). Periventricular leukomalacia is caused by a lack of oxygen or blood flow to the periventricular area of the brain, which results in the death or loss of brain tissue. PVL involvement of extrastriate association cortex may result in other classical findings of difficulties with object recognition, motion detection, and visual attention10. 2003 Gordon Dutton. Cleveland Clinic is a non-profit academic medical center. Chronic cortical visual impairment in children: aetiology, prognosis, and associated neurological deficits. The 2023 edition of ICD-10-CM G93.89 became effective on October 1, 2022. It is thought that other factors might lead to PVL, and researchers are studying other potential pathways. doi:10.1001/archneur.1978.00500320037008. Pathologic changes consisted of infarction and demyelination of periventricular white matter, with associated necrotic foci in the basal ganglia in some cases. PVL is anticipated to become more prevalent due to advances in perinatal care and consequent improved survivorship. Periventricular leukomalacia causes cell damage to the brain's periventricular tissue as well as a decrease in blood flow. These treatments may include: You cant reduce your childs risk of PVL. Children whore born prematurely are at higher risk of PVL. MeSH Read any comments already posted on the article prior to submission. All treatments administered are in response to secondary pathologies that develop as a consequence of the PVL. Avoiding premature birth allows the fetus to develop further, strengthening the systems affected during the development of PVL. : "Prediction of periventricular leukomalacia in neonates after cardiac surgery using machine learning algorithms . What Is Periventricular Leukomalacia? Although the incidence of the most severe cystic form . There is loss of normal periventricular white matter, with associated gliosis and thinning of the corpus callosum. Periventricular leukomalacia (PVL) Periventricular leukomalacia (PVL) is damage and softening of the white matter within the brain near the cerebral ventricles. 2. Periventricular Leukomalacia refers to the damage and cell death in the tissues of the white matter. Children affected by this condition may have extreme mental and physical impairments. A lack of blood flow to the brain tissue before, during, or after birth causes PVL. Findings are usually consistent with white matter loss and thinning of periventricular region. De Reuck JL, Eecken HMV. However, other differential diagnoses include ischemic, infectious, inflammatory, compressive, congenital, and toxic-nutritional etiologies. Physiol Res. However, since healthy newborns (especially premature infants) can perform very few specific motor tasks, early deficits are very difficult to identify. Bethesda, MD 20894, Web Policies BMC Neurol. FOIA [6][8] Many patients exhibit spastic diplegia,[2] a condition characterized by increased muscle tone and spasticity in the lower body. Would you like email updates of new search results? The percentage of individuals with PVL who develop cerebral . The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Periventricular leukomalacia (PVL) is a form of white-matter brain injury, characterized by the necrosis . The typical distribution of PVL has been correlated . 2015 Apr 30;15:69. doi: 10.1186/s12883-015-0320-6. Those generally considered to be at greatest risk for PVL are premature, very low birth-weight infants. 2021;77(2):147-153. doi:10.1016/j.mjafi.2020.05.013, 7. Kato T, Okumura A, Hayakawa F, Kuno K, Watanabe K. The evolutionary change of flash visual evoked potentials in preterm infants with periventricular leukomalacia. Among the recent findings directly in human postmortem tissue is that immunocytochemical markers of lipid peroxidation (hydroxy-nonenal and malondialdehyde) and protein nitration (nitrotyrosine) are significantly increased in PVL. Carbon monoxide intoxication was excluded. However, diffuse lesions without necrosis are not PVL. But thiamine deficiency by severe malabsorption was the probable cause of this neurologic complication. Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) White matter disease differs from PVL in that it occurs in certain adults, not babies. An official website of the United States government. Premature children have a higher risk of PVL. An official website of the United States government. Surv Ophthalmol. Periventricular leukomalacia (PVL) refers to ischemia occurring in the periventricular white matter and centrum semiovale, commonly in the preterm infants, and less commonly in the term infants. However, neuro-ophthalmic presentation of PVL is highly variable. Periventricular leukomalacia involves death of the white matter surrounding the lateral ventricles in fetuses and infants. The https:// ensures that you are connecting to the Risk factors for white matter changes detected by magnetic resonance imaging in the elderly. Two major factors appear to be involved in the development of PVL: (1) decreased blood or oxygen flow to the periventricular region (the white matter near the cerebral ventricles) and (2) damage to glial cells, the cells that support neurons throughout the nervous system. Periventricular leukomalacia (PVL) is a form of white-matter brain injury, characterized by the necrosis (more often coagulation) of white matter near the lateral ventricles. Researchers have begun to examine the potential of synthetic neuroprotection to minimize the amount of lesioning in patients exposed to ischemic conditions.[15]. 3 - Visual Loss: Overview, Visual Field Testing, and Topical Diagnosis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Pediatr Res. However, the correction of these deficits occurs "in a predictable pattern" in healthy premature infants, and infants have vision comparable to full-term infants by 36 to 40 weeks after conception. The disorder is caused by a lack of oxygen or blood flow to the periventricular area of the brain. Clusters of reduced FA were associated with lower birth weight and perinatal hypoxia, and with reduced adult cognitive performance in the VPT group only. In the process of morphogenesis focuses PVL pass through three stages: 1) necrosis, 2) resorption, and 3) the formation gliosis scars or cysts. The white matter in the periventricular regions is involved heavily in motor control, and so individuals with PVL often exhibit motor problems. The more premature your child is, the higher the risk. Would you like email updates of new search results? Non-economic damages are subject to caps in states which allow damages caps for birth injury claims. [9] These factors are especially likely to interact in premature infants, resulting in a sequence of events that leads to the development of white matter lesions. official website and that any information you provide is encrypted Many infants with PVL eventually develop cerebral palsy. Get useful, helpful and relevant health + wellness information. 2000;214(1):199-204. doi:10.1148/radiology.214.1.r00dc35199, 10. La CP (parlisis cerebral) es un trastorno neurolgico a menudo causado por eventos en los primeros aos de vida que afectan la funcin neurolgica en varios niveles. De Reuck J, Schaumburg HH: Periventricular atherosclerotic . Periventricular leukomalacia (PVL) is a brain injury disorder characterized by the death of the white matter of the brain due to softening of the brain tissue. If you are experiencing issues, please log out of AAN.com and clear history and cookies. 2005 Dec;20(12):940-9. doi: 10.1177/08830738050200120301. Learn about clinical trials currently looking for people with PVL at, Where can I find more information about p. Did you find the content you were looking for? Children with PVL should receive regular medical screenings to determine appropriate interventions. Progressive multifocal leukoencephalopathy: a rare cause of cerebellar edema and atypical mass effect. This site needs JavaScript to work properly. We have changed the login procedure to improve access between AAN.com and the Neurology journals. The characteristic neuroimaging features on computed tomography (CT) and magnetic resonance imaging (MRI) of PVL are summarized in Table 4. Laboratory testing is not typically necessary for PVL diagnosis. 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. Periventricular leukomalacia (PVL) is a kind of brain damage that occurs to the inner part of your brain (white matter). The ventricles are fluid-filled chambers in the brain. Periventricular leukomalacia (PVL) is a form of ischemic white matter lesion which affects premature infants especially ones with cardiorespiratory abnormalities and sepsis.Very low birth weight (VLBW) infants between 24-32 weeks gestation are most vulnerable but mature infants, especially those with congenital heart disease, may be affected. If the specialist finds any issues, they can find ways to help as soon as possible. The most common form of brain injury in preterm infants is focal necrosis and gliosis of the periventricular white matter, generally referred to as periventricular leukomalacia (PVL). Periventricular leukomalacia symptoms can range from mild to life-limiting. Chhablani PP, Kekunnaya R. Neuro-ophthalmic manifestations of prematurity. Fetal blood vessels are thin-walled structures, and it is likely that the vessels providing nutrients to the periventricular region cannot maintain a sufficient blood flow during episodes of decreased oxygenation during development. 2000;45(1):1-13. doi:10.1016/s0039-6257(00)00134-x, 5. Reperfusion of ischemic tissue is associated with vascular injury, increased reactive oxygen and nitrogen species production, and abnormal inflammation5,8. [from HPO] Children and adults who have a rare disease and their caregivers are encouraged to talk about their needs with the medical team and to reach out for the support they require. Prenatal treatment focusing on delaying premature membrane rupture and parturition would prevent PVL by allowing more time for periventricular vascular development and by avoiding hypoxic-ischemic events. Submissions should not have more than 5 authors. 3. Perinatal white matter injury: the changing spectrum of pathology and emerging insights into pathogenetic mechanisms. Neurobiology of Periventricular Leukomalacia in the Premature Infant. Despite the varying grades of PVL and cerebral palsy, affected infants typically begin to exhibit signs of cerebral palsy in a predictable manner. Premature birth is a strong risk factor for PVL. Periventricular leukomalacia is a brain disorder occurring in prematurely born babies which is characterized by brain damage with softening and death of the inner part of the brain. They can help connect patients with new and upcoming treatment options. Optimal management of PVL includes not only care for ocular complaints but also interdisciplinary management involving speech therapy, physiotherapy, and cognitive therapy. Advertising on our site helps support our mission. Periventricular leukomalacia (PVL)is characterized by the death of the brain's white matter due to softening of the brain tissue. doi: 10.1001/archneur.1978.00500320037008. In severe cases, post-mortem examinations revealed that 75% of premature babies who died shortly after birth had periventricular leukomalacia. Epub 2014 Jun 17. Periventricular leukomalacia is a form of brain injury and one of the important causes of cerebral palsy and cognitive issues in premature infants.1 Various studies are being conducted to assess the use of better diagnostic methods and treatment modalities for Periventricular leukomalacia. You must have updated your disclosures within six months: http://submit.neurology.org. However, extent of improvement, if any, is highly dependent on degree of cerebral injury as well as time of diagnosis and of starting rehabilitation. Neoreviews (2011) 12 (2): e76-e84. Theyll also give your child a physical exam. Ment Retard Dev Disabil Res Rev. These infants are typically seen in the NICU in a hospital, with approximately 4-20% of patients in the NICU being affected by PVL. Pattern recognition in magnetic resonance imaging of white matter disorders in children and young adults. Periventricular leukomalacia. Please enable it to take advantage of the complete set of features! Postradiation encephalopathy. and transmitted securely. However, the strongest and most direct risk factor for PVL is perinatal hypoxia8. (2005) Oxidative and nitrative injury in periventricular leukomalacia: a review. Increased signal intensity in the periventricular region on T2-weighted MRI and findings of decreased white matter in the periventricular region are diagnostic of PVL (Figure 1). Some children exhibit fairly mild symptoms, while others experience significant disabilities. Careers. They may suggest other tests as well, including: There isnt a cure for PVL. 2009;98(4):631-635. doi:10.1111/j.1651-2227.2008.01159.x, 17. Infants with severe PVL suffer from extremely high levels of muscle tone and frequent seizures. The initial hypoxia (decreased oxygen flow) or ischemia (decreased blood flow) can occur for a number of reasons. PVL can affect fetuses or newborns, although premature babies are at greatest risk. Periventricular leukomalacia (PVL) is a term used to describe cerebral white matter injury with both focal and diffuse components. 779.7 - Perivent leukomalacia. Correlation of ultrasound, clinical, and nuclear magnetic resonance functions", "Epilepsy in children with cerebral palsy", https://en.wikipedia.org/w/index.php?title=Periventricular_leukomalacia&oldid=1136409434, Drawing of the lateral and third ventricles of the brain. The .gov means its official. You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid [1] Cysts occur when large and confluent focuses of PVL, with mixed necrosis (kollikvacia in the center and coagulation rim at the periphery). Abstract. All Adult Pediatric Patient Graphics. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. This tissue is located near the fluid-filled ventricles in the brain. Epub 2002 Nov 20. FOIA "Leuko" refers to the brain's white matter. Indian J Pediatr. Significant visual involvement classically presents in infants and children with symptoms of visual inattention, diplopia, difficulty with fixating on faces, perception of motion, depth perception4, a characteristic squint11, and difficulty maintaining eye contact12. Periventricular leukomalacia (PVL) develops when the white matter of the brain is damaged during childbirth. Severe white matter injury can be seen with a head ultrasound; however, the low sensitivity of this technology allows for some white matter damage to be missed. Date 06/2024. Treatments for PVL focus on improving your childs quality of life. NOTE: The first author must also be the corresponding author of the comment. Published online 1974. doi:74:591-600. . Susceptibility can be attributed, at least in part, to a relative deficiency of superoxide dismutases in the preterm white matter, including premyelinating oligodendrocytes. 8600 Rockville Pike White matter exists around the spaces in your brain that contain fluid (ventricles). Periventricular leukomalacia occurs when the delicate brain tissues that sit around the ventricles die due to one or more acute mechanisms. [2] Episodes of hypotension or decreased blood flow to the infant can cause white matter damage. Disclaimer. Longitudinal follow-up with repeat visual field and OCT are helpful in differentiating PVL related optic atrophy from normal tension glaucoma. Med J Armed Forces India. Periventricular Leukomalacia (PVL) is a brain abnormality that occurs following an injury to a specific region of the brain. [1], Animal models are frequently used to develop improved treatments for and a more complete understanding of PVL. The celebratory month has become an international phenomenon with events throughout the world. In cases where perinatal hypoxic brain injury has already occurred, use of hypothermia as neuroprotective treatment has been studied16. Unauthorized use of these marks is strictly prohibited. 1982. Magnetic resonance imaging (MRI) is much more effective at identifying PVL, but it is unusual for preterm infants to receive an MRI unless they have had a particularly difficult course of development (including repeated or severe infection, or known hypoxic events during or immediately after birth). 1980 Aug;20(1):33-41. doi: 10.1007/BF00346859. Summary. Babies with PVL generally have no outward signs or symptoms of the disorder, but they are at risk for: PVL may be accompanied by a hemorrhage or bleeding in the periventricular-intraventricular area and can lead to cerebral palsy. No, I did not find the content I was looking for, Yes, I did find the content I was looking for, Please rate how easy it was to navigate the NINDS website. This delicate brain tissue is called white matter, and white matter is the tissue responsible for the production of myelin, a fatty substance that covers and protects the nerve axons, allowing impulses to . Indian J Ophthalmol. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Ringelstein EB, Mauckner A, Schneider R, Sturm W, Doering W, Wolf S, Maurin N, Willmes K, Schlenker M, Brckmann H, et al. 2. A preterm baby delivered by caesarian section at 35 weeks gestation with low APGAR scores on MRI ( for seizures) shows extensive cytotoxic edema of the white matter tracts including gangliocapsular, pyramidal tracts and corpus callosum with . J Formos Med Assoc. Clin Neurophysiol. [citation needed], Please help improve this article, possibly by. Effects of enzymatic blood defibrination in subcortical arteriosclerotic encephalopathy. It is common in very premature (less than 34 weeks gestational age), low birthweight babies (less than 1500 grams). sharing sensitive information, make sure youre on a federal Periventricular Leukomalacia Information Page. . For ophthalmologists caring for adult patients with a history of childhood PVL, it is essential to understand the nuances that differentiate PVL related pseudo-glaucomatous cupping from normal tension glaucoma. The optic radiations, which may be damaged in the periventricular region, originate from the lateral geniculate nuclei and are topographically organized both anatomically and functionally. All Rights Reserved. From the Department of Neurology, University of Ghent, Belgium. Information may be available from the following resource: Form Approved OMB# 0925-0648 Exp. Periventricular leukomalacia: Relationship between lateral ventricular volume on brain MR images and severity of cognitive and motor impairment. Cystic periventricular leukomalacia: sonographic and CT findings. For information about participating in clinical research visit, . It is important to differentiate PVL from the following major white matter lesions in the cerebral hemispheres: edematous hemorrhagic leukoencephalopathy (OGL), telentsefalny gliosis (TG), diffuse leukomalacia (DFL), subcortical leukomalacia (SL), periventricular hemorrhagic infarction (PHI), intracerebral hemorrhage ( ICH), multicystic encephalomalacia (ME), subendymal pseudocyst. There are many ways to receive support: [20] Many of these affected patients exhibit some seizures, as well as spastic diplegia or more severe forms of cerebral palsy, before a diagnosis of epilepsy is made. Because their cardiovascular and immune systems are not fully developed, premature infants are especially at risk for these initial insults. Ongoing therapy helps children live with the condition. The Near-Term (Late Preterm) Human Brain and Risk for Periventricular Leukomalacia: A Review. 2001;50(5):553-562. doi:10.1203/00006450-200111000-00003, 14. Treatment is symptomatic and supportive. The following code (s) above G93.89 contain annotation back-references that may be applicable to G93.89 : G00-G99. Periventricular leukomalacia -MRI. Several cytokines, including interferon-gamma (known to be directly toxic to immature oligodendroglia in vitro), as well as tumor necrosis factor-alpha and interleukins 2 and 6, have been demonstrated in PVL. [9] Seizures are typically seen in more severe cases of PVL, affecting patients with greater amounts of lesions and those born at lower gestational ages and birth weights. Uncommon extensive juxtacortical necrosis of the brain. [5], Although no treatments have been approved for use in human PVL patients, a significant amount of research is occurring in developing treatments for protection of the nervous system. Children with PVL may live from a few months to a full lifetime. PVL and other in utero or neonatal insults, however, can produce trans-synaptic degeneration across the lateral geniculate body and thus produce optic atrophy mimiciking pre-geniculate lesions in adults. Although PVL is well known among pediatric ophthalmologists, adults may present with neuro-ophthalmic findings of childhood PVL. Your organization or institution (if applicable), e.g. The white matter in preterm born children is particularly vulnerable during the third trimester of pregnancy when white matter developing takes place and the myelination process starts around 30 weeks of gestational age.[3]. Periventricular leukomalacia (PVL) is characterized by the death of the brain's white matter due to softening of the brain tissue. Periventricular Leukomalacia in Adults: Clinicopathological Study of Four Cases. Virchows Arch A Pathol Anat Histol. Abstract. Minor white matter damage usually is exhibited through slight developmental delays and deficits in posture, vision systems, and motor skills. Many infants with PVL eventually develop cerebral palsy. It sends information between the nerve cells and the spinal cord, and from one part of the brain to another. Single-Cell Analysis of the Neonatal Immune System Across the Gestational Age Continuum. 'MacMoody'. Lines and paragraphs break automatically. Chattha AS, Richardson EP: Pathogenesis and evolution of periventricular leukomalacia in infancy . The outlook for individuals with PVL depends upon the severity of the brain damage. Your email address, e.g. A Cross-Sectional Study in an Unselected Cohort, Neurology | Print ISSN:0028-3878 Clipboard, Search History, and several other advanced features are temporarily unavailable. Made available by U.S. Department of Energy Office of Scientific and Technical Information . The site is secure. Distributing copies (electronic or otherwise) of the article is not allowed. We propose that the prolonged hypoxia and ischemia produce a "no reflow" phenomenon causing brain edema (more pronounced in the white matter); this resulted in infarctions of white matter in the periventricular arterial end and border zones. All types of volunteers are neededthose who are healthy or may have an illness or diseaseof all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them. government site. Epub 2017 Nov 6. Affected individuals generally exhibit motor control problems or other developmental delays, and they often develop cerebral palsy or epilepsy later in life. Nitrosative and oxidative injury to premyelinating oligodendrocytes in periventricular leukomalacia. Zaghloul. J Child Neurol. Periventricular Leukomalacia in Adults: Clinicopathological Study of Four Cases. Applicable To. Their lifespan depends on the amount and severity of their symptoms, such as: You can take care of your child with PVL by making sure they receive regular evaluations by a developmental specialist. Microglia, which express toll-like receptors to bacterial products such as lipopolysaccharide, are increased in PVL white matter and may contribute to the injury. Association between perinatal hypoxic-ischemia and periventricular leukomalacia in preterm infants: A systematic review and meta-analysis. Glial function (and dysfunction) in the normal & ischemic brain. [6] These developmental delays can continue throughout infancy, childhood, and adulthood.