In the brain, there are areas of white matter that transport neural signals to the areas of gray matter. When these areas of white matter die or begin decaying, it is known as periventricular leukomalacia. Periventricular leukomalacia causes holes and serious damage to the brain. A fetus or infant who suffers from this condition may develop neurological disorders, cerebral palsy, vision and hearing problems, and disabilities.
Though periventricular leukomalacia can occur in adults, it is almost exclusively found in fetuses and newborns. This is because the ventricles and white matter of the brain are especially vulnerable during development and are more susceptible to injury. Periventricular leukomalacia is caused by a drop in the supply of blood and oxygen to the brain, and this can occur during development in the womb, during the delivery, or in the first few days after birth. There are multiple periventricular leukomalacia causes that are especially relevant for fetuses and newborns.
Periventricular Leukomalacia Causes Related to Blood Flow
Because this condition occurs when the white matter stops receiving blood and oxygen, the major periventricular leukomalacia causes are all related to the fetus or newborn’s supply of blood to the brain. If the baby has hypotension or other causes of low blood flow, there is a greater risk of PVL occurring. Intraventricular hemorrhages may cause a sudden drop in blood pressure and supply in other areas of the brain, and this can also be the cause of periventricular leukomalacia.
If the mother is pregnant with multiple fetuses, there is a greater risk of problems with blood and oxygen supply because the demands for blood and oxygen are much greater. Additionally, problems with the placenta and the mother’s blood pressure such as placental abruption, chronic hypertension, and preeclampsia may cause sudden changes in the blood flow to the fetus’s brain. For example, preeclampsia may damage the blood vessels in the placenta, reducing the ability of the mother to provide oxygen to the fetus.
Infection Periventricular Leukomalacia Causes
Scientists have also discovered that certain maternal infections may cause periventricular leukomalacia. Unlike other periventricular leukomalacia causes, these infections typically do not cause sudden changes in blood flow. Instead the infections release toxins in the amniotic membranes that affect the development of the brain and the blood vessels in the brain. These malformations can later cause PVL as the fetus continues to develop.
In addition, inflammation of amniotic membranes and the umbilical cord can increase the risk of PVL. Sepsis, an illness that causes large amounts of bacteria in the blood, can also cause the white matter in the brain to die and result in periventricular leukomalacia.
Other Periventricular Leukomalacia Causes
There are many other conditions that may cause PVL or increase the risk of PVL in fetuses and newborns. Premature newborns are at a much higher risk than others to suffer from PVL. This is because the white matter of the brain is very fragile at early stages of development, and if a baby is delivered prematurely, the brain will be extremely vulnerable to stress, trauma, and infection. Research has also suggested that maternal cocaine use and vaginal bleeding may also be related to periventricular leukomalacia.
Like other birth injuries to the brain, periventricular leukomalacia can also be caused by extreme cases of birth trauma and medical malpractice. If the physician during delivery does not exercise reasonable care, the baby’s head may experience significant physical trauma which can cause skull fractures, hemorrhages, and other brain damage that can lead to PVL. Additionally, if asphyxiation occurs during delivery and is not addressed immediately, this can be a direct cause of periventricular leukomalacia and other forms of brain ischemia.