What Are The Symptoms Of Periventricular Leukomalacia?

Periventricular leukomalacia is a form of injury to the brain of a baby with a range of adverse effects related to motor skills and the nervous system. Periventricular leukomalacia most commonly occurs in babies with a very low birth weight or those born very prematurely. A baby's brain contains ventricles or chambers filled with cerebrospinal fluid. A substance called white matter sits in between the ventricles in the interior brain tissues that relays information between the individual's spinal cord and nerve cells.

The white matter is also responsible for transmitting information from one region of the brain to another. Periventricular leukomalacia happens in babies when the white matter tissues have died or become damaged. The mechanism that precipitates periventricular leukomalacia is attributed to the absence of adequate blood flow during, before, and after birth.

Developmental Delay

An individual with periventricular leukomalacia can experience developmental delays in a physical or neurological domain. Developmental delay is a term used to describe when a child does not accomplish the developmental milestones expected of children of the same age. A developmental delay does not refer to when a child has a temporary lag behind other children of a similar age but refers to an ongoing minor or major delay in the development process.

Periventricular leukomalacia can cause a child to have delays in physical development, such as in their gross and fine motor skills. It may also cause a child to experience delays in cognitive development or intellectual abilities. Communication development, like speech and language, may also be impacted by this condition. Development in the emotional and social realm, like emotional control and social skills, may present as delayed. Developmental delays can also occur with a child's adaptive development or their self-care skills.

Issues With Movement And Motor Skills

Periventricular leukomalacia patients may exhibit issues with movement and motor skills. The most common movement abnormality or symptom seen in individuals with periventricular leukomalacia is spastic diplegia or quadriplegia. Spastic diplegia refers to the exaggerated reflexes and jerky movements made by the affected individual's legs, while spastic quadriplegia refers to exaggerated reflexes and jerky movements in all four limbs. These abnormal movements happen because the muscles of the limbs are too tight to bend and flex properly.

This malfunction is due to impaired nerve impulse signaling from the brain to the nerves and from the nerves to the muscles. In rare and severe cases of periventricular leukomalacia, a patient may experience numbness, tingling, and paralyzation of one or more of their limbs as a result of their condition. Most periventricular leukomalacia patients have significant challenges with walking or are confined to a wheelchair.

Low Heart Rate

Individuals with periventricular leukomalacia may experience a low heart rate (bradycardia) due to the underlying damage done to the white matter tissues in their brain. This symptom typically occurs early on in the disease process because it can also be part of the causative action that produces periventricular leukomalacia. Periventricular leukomalacia happens due to a brain injury that causes the tissues in the brain to become deprived of blood and oxygen in the time before, during, or after the individual's birth. The mechanism by which caused the ischemic injury to the brain may have influenced the ability of the heart to pump blood effectively to the brain.

In other cases, the injury happens as the result of a noncardiac related mechanism but produces bradycardia episodes due to a natural compensative process. The body naturally has certain programmed mechanisms that are activated when things go wrong in the body. One of these autoregulatory mechanisms involves increasing the flow of blood to the brain at the expense of the muscle tissues, including those of the heart. This autoregulatory mechanism can be inappropriately triggered in perventricular leukomalacia patients, resulting in episodes of low heart rate.

Visual Impairment And Eye Conditions

An individual who experiences visual impairment and eye conditions may be affected by periventricular leukomalacia. The leading cause of visual dysfunction and impairment in children who are born prematurely is periventricular leukomalacia. The visual impairments are best characterized by visual maturation delay, abnormal visual acuity, defects in the visual field, crowding, and visual perceptual-cognitive problems. Visual perception delay defines a child who is unable to follow or fix objects with their eyes in the space around them but usually exhibits an improvement before reaching six months old.

Abnormal visual acuity defines when an affected individual has an alteration in what would be the normal sharpness of their vision. An individual who has defects in their visual field has a small spot of blindness within the normal visual field of one or both of their eyes. An affected individual may experience an inability to identify or recognize single objects when they are placed in an environment of general clutter, which is a defect referred to as crowding. A periventricular leukomalacia patient may have problems with visual perceptual cognition, or an inability to properly locate and extract visual information from the space around them.

Seizures

A periventricular leukomalacia patient may experience seizures as a symptom of their brain injury. A seizure describes a medical event where an individual experiences a storm of sudden and abnormal electrical activity in their brain that may result in loss of consciousness, convulsions, and uncontrollable shaking. Seizures usually do not produce long term effects or harm in an affected individual and last between thirty seconds and two minutes.

Epilepsy is a long term condition where a patient has multiple seizures that may or may not have certain triggers. Around one-third of all individuals affected by periventricular leukomalacia eventually develop epilepsy. In neonates, epilepsy may not be obvious enough to identify on observation alone. MRI scan findings can help identify a patient who has experienced multiple seizures. There are several different types of seizures, and complex partial seizures are the most common type seen in individuals who have periventricular leukomalacia.