Periventricular leukomalacia is a type of brain injury in premature babies. PVL is characterized by damage or decay of the white matter in the brain ventricles. This area of cell decay leaves holes in the brain that eventually fill with fluid. This white matter plays a key role in the normal transmission of electrical impulse signals within the brain. Periventricular leukomalacia is one of the leading causes of cerebral palsy and it can also cause developmental delays and epilepsy.
One of the primary causes of periventricular leukomalacia is believed to be a reduction of blood or oxygen flow to the brain of a developing fetus during pregnancy. During early gestation, the ventricles within the brain of the baby are particularly vulnerable to developmental interruption and injury. Reduced blood, oxygen or nutrient flow from mother to baby at this time can result in damage. PVL can also be caused by maternal infections or infections of the fetal membranes (chorioamnionitis) near the time of delivery which interrupt blood and oxygen flow.
No. PVL is not a condition that will gradually get worse as a child ages so it is not considered a progressive disease. Once the damage to the white matter in the brain occurs during development it does not expand after birth. The noticeable symptoms of PVL and related conditions may become more noticeable as the child develops.
PVL CP generally refers to a case of cerebral palsy that was caused by periventricular leukomalacia. PVL is one of the leading causes of cerebral palsy.
PVL is not the same thing as cerebral palsy. Cerebral palsy is a neurological disorder that limits the ability to control muscle movement and body control. Cerebral palsy is generally caused by damage to a baby's brain during pregnancy. PVL is a specific type of brain injury occurring during pregnancy. PVL is the type of brain injury that most frequently results in a cerebral palsy but they are not the same thing.
When a baby is born with PVL the condition is typically not diagnosed until months later. Symptoms of PVL are often different in each child. Some of the more common physical symptoms of PVL include:
- Developmental delays
- Trouble with body control
- Muscle contractions or tightness (particularly in the legs)
- Vision problems and poor eye control
Some babies with PVL may also experience clinical seizures. Most of the various symptoms of PVL are also symptoms of other birth injuries or conditions.
A definitive diagnosis of PVL can be a complex process requiring a series of diagnostic brain tests. The first diagnostic tool utilized in a PVL diagnosis is a cranial ultrasound. This is basically an ultrasound (just like a pregnancy ultrasound) performed on the baby's head that provides images of the brain. A cranial ultrasound can be used to identify abnormalities in the brain caused by PVL. Additional diagnostic imaging tests, including a Computed Tomography ("CT") scan and an MRI (Magnetic Resonance Imaging), are also utilized to evaluate the extent or severity of PVL.
White matter disease is the deterioration of white matter tissue in the brain. White matter is the home for the network of nerve fibers that connect the brain to the spinal cord. The brain uses these nerve pathways through the spine to send impulse signals that control body movement. The nerve fibers are coated in a white fatty substance called myelin. White matter disease occurs when myelin breaks down and wears away which interrupts control signals from the brain.
White matter deterioration usually presents itself in older patients. Damage to white matter can be caused over time by a number of known health conditions and other factors including chronic high blood pressure, chronic blood vessel inflammation, and smoking. Diabetes and genetic predisposition are factors that put individuals at increased risk of white matter damage.
There currently is no known cure for white matter disease. Once the white matter is damaged it cannot be restored or reversed.
There is no effective treatment that will restore white matter. Instead, treatment of white matter disease focuses on slowing down or stopping the condition from getting worse. This will involve treatment of the underlying conditions that are causing the white matter to decay - such as high blood pressure or cholesterol.
Unfortunately, there is no known treatment for PVL. The damaged and decayed white matter in the brain can never be restored. PVL is a permanent condition, however, effective management and careful monitoring can help limit the impact of PVL. Physical and occupational therapy can also be used to help deal with PVL.
Like all birth injuries, PVL can often be the result of negligent medical care during pregnancy or delivery. PVL is known to be caused by a loss of blood or oxygen flow to a baby's brain during pregnancy. There are a number of conditions and complications during pregnancy that can interrupt or restrict blood and oxygen flow. Doctors have a legal obligation to properly monitor a pregnant mother and timely diagnose these conditions when they arise. They also have a duty to effectively treat and manage these conditions in accordance with acceptable medical practices. The reality is that OBGYNs and hospital delivery teams often make mistakes. Complications such as maternal infections or fetus infections (chorioamnionitis) frequently go undetected. Delayed responses and mistakes in treatment occur just as frequently. These sort of medical errors can result from a variety of factors including poor communication between doctors; improper testing or monitoring, and so forth.
When negligent care results in birth injuries such as PVL the financial, emotional and physical impact can be devastating. PVL is a permanent condition that can result in cerebral palsy and other serious developmental conditions. Aside from the obvious physical impairments, these conditions can cause a lifetime of financial hardship. This is why our legal system enables victims of medical malpractice to obtain financial compensation.
- This is an example of a PVL birth injury lawsuit filed in Maryland in January 2018.
- This is another PVL lawsuit filed in March 2018
- Dixon v NYC Health (New York 2019) - $1,750,000 Settlement: A baby's family sues after the hospital allegedly mismanages his birth by failing to properly recognize and respond to indications of fetal distress and perform an emergency C-section. Plaintiff suffers periventricular leukomalacia (PVL) brain injury as a result of delivery room negligence. This result is major developmental delays. The hospital disputes that the plaintiff even had PVL, arguing that his condition was caused by congenital defects. The suit eventually settles for $1.7 million.
- Plaintiff v. Defendant (California 2017) - $2.5 Million Settlement. A newborn develops periventricular leukomalacia, a brain bleed and cerebral palsy after premature delivery at 26 weeks Plaintiffs' lawsuit alleged that the doctors should have diagnosed the mother's bowel obstruction that could have been uncovered from a simple ultrasound. Plaintiffs also alleged negligent care after delivery. The case settled for $2.5 million
- I.H. v. Holy Redeemer Hospital (Pennsylvania 2017) - $2 Million Settlement Baby suffered brain damage due to a lack of oxygen for approximately twelve minutes during the birthing process when her neck and the umbilical cord was entrapped by the mother's cervix. The child now suffers from cerebral palsy as a result of the hypoxia and periventricular leukomalacia. The child and her parents filed a birth injury lawsuit alleging that a c-section should have been performed The case settled for $2 million before trial.
- M.A. Pro Ami v. St. Joseph Med. Center (Maryland 2015) - $2 Million Verdict: The baby was born prematurely via c-section and was later diagnosed with PVL and cerebral palsy. Plaintiff alleged that the doctor was negligent in failing to monitor and recognize certain complications and in delivering the baby too early.
- Zaya v. Rush Health System (Illinois 2015) - $1.5 Million Settlement: Plaintiff alleged that her doctors were negligent in failing to timely treat her chorioamnionitis infection with antibiotics. As a result of the untreated infection, her baby was born with PVL and had permanent vision loss and developmental delays.
- Smith v. Lee Memorial Health System (Florida 2015) - $19 Million Verdict: Hospital and doctors were negligent in failing to diagnose a maternal infection during pregnancy and in administering an overdose of drugs in response. Baby born with PVL as a result leaving her confined to a wheelchair.
If your child was diagnosed with PVL or another serious birth injury as a result of negligent medical care, please contact Miller & Zois. Our attorneys have handled hundreds of birth injury claims. We can investigate your case and evaluate your claims at no cost to you. Call us at 800-553-8082 or click here for a free online consultation.