Prematurity and Periventricular Leukomalacia

Risk Factors and Clinical Manifestations

Prematurity is the most strongly associated factor with periventricular leukomalacia, representing the primary risk factor and underlying pathophysiological mechanism for developing this condition, according to the American Academy of Neurology 1
The incidence of severe periventricular hemorrhagic infarction reaches 30% in infants born at 22 weeks and decreases to 3% at 28 weeks gestational age, highlighting the vulnerability of preterm infants 1
Bilateral lower limb spasticity is a characteristic clinical manifestation of periventricular leukomalacia, but it is a consequence of the condition, not the underlying cause, as noted by the American Academy of Pediatrics 2
Static motor delay is an outcome of periventricular leukomalacia, but it is a broad category that could result from many conditions, according to the American College of Medical Genetics 2

43% of infants with cystic PVL also have intraventricular hemorrhage (IVH), requiring monitoring for both conditions, as recommended by the Society for Pediatric Radiology 1, 3
Bilateral cystic PVL specifically predicts nonambulant cerebral palsy with more severe motor impairment, while noncystic PVL is more likely to result in ambulant cerebral palsy, according to the American Academy for Cerebral Palsy and Developmental Medicine 2
Serial imaging is essential as early changes may be subtle or absent initially, as suggested by the International Society for Pediatric Neurosurgery 3
Cerebellar hemorrhage co-occurs in 10% of preterm infants with PVL and increases the risk of abnormal neurological outcomes 5-fold, highlighting the need for close monitoring, as recommended by the Child Neurology Society 3

The incidence of cerebral palsy in preterm infants has decreased 3-fold from the early 1990s to early 2000s, largely due to a 93% reduction in cystic periventricular leukomalacia, according to the American Academy of Neurology 4, 5