Periventricular Leukomalacia

  • Etiology:
    — Hypotension in watershed or endarterial regions leads to necrosis of periventricular white matter especially near frontal horns and trigones
    — Often bilateral and symmetric (nonhemorrhagic ischemic necrosis, watershed ischemic infarct) = arterial dry infarct
  • Imaging US:
    — Bilateral and symmetric
    — Early see periventricular edema and echogenicities and later see periventricular cysts
  • DDX: Normal peritrigonal blush, periventricular hemorrhagic infarct, edema
  • Complications:
    — Non-cystic periventricular leukomalacia – hypomyelination or gliosis due to axonal and neuronal damage,
    — Cystic periventricular leukomalacia – focal necrosis with loss of all cellular elements forming porencephalic cysts
  • Treatment:
  • Clinical: Most frequent brain lesion in preterm infants

Radiology Cases of Periventricular Leukomalacia

Head US of periventricular leukomalacia
Coronal (above) and left sagittal (lower left) and right sagittal (lower right) US of the brain shows bilateral increased echogenicity in the periventricular white matter posterior to the lateral ventricles that has multiple cysts present within it bilaterally.
US and MRI of periventricular leukomalacia and porencephaly
Coronal US of the brain on day of life 3 (above left) shows bilateral increased periventricular echogenicity. Coronal US of the brain on day of life 30 (above right) shows the previously seen areas of increased periventricular echogenicity to have undergone cystic transformation bilaterally. Axial T2 MRI without contrast of the brain at 3 months of age (below) shows an irregular contour and appearance to the occipital horns of the lateral ventricles.