Periventricular leukomalacia -MRI

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 periventricular punctate haemorrhagic foci (3 in number) with relatively normal gray matter and subcortical regions possibly representing periventricular leukomalacia (PVL), the form of neonatal encephalopathy.

Teaching points by Dr MGK Murthy:

1. PVL may or may not have long term morbidity

2. MRI is more sensitive and specific not only for diagnosis but also for    quantification and grading. Some of the patients may progress to cerebral palsy or delayed milestones.

Sie et al described an MRI grading system for PVL:

• Grade I - Normal MRI
• Grade II - Altered periventricular intensity
• Grade III - Fewer than 6 punctuate hemorrhages in the white matter
• Grade IV - Multiple punctuate hemorrhages, a few large focal hemorrhages, and/or small periventricular cysts
• Grade V - Extensive signal intensity changes within hemorrhagic and/or cystic lesions in the white matter, with minimal focal extension into the subcortical region
• Grade VI - Diffuse signal intensity changes within hemorrhagic and/or cystic lesions in the white matter and subcortical region