Periventricular Leukomalacia (PVL)

It’s a complicated name for a complicated condition. Drawn from three medical terms, periventricular (around or near the ventricles of the brain), leuko (white) and malacia (softening), periventricular leukomalacia (PVL) is a kind of brain damage affecting white matter in the brain. Predominantly a movement disorder that creates problems with muscle control (tight or spastic muscles), children with PVL may also experience learning disabilities and other cognitive impairment. They also have an increased risk of developing cerebral palsy.

Although PVL is the second most common central nervous system problem in premature infants, there is still much unknown about this condition. It is known, however, that PVL can be caused by impaired fetal oxygenation, usually, but not exclusively, in pre-term fetuses.

Premature fetuses exposed to hypoxia-ischemia tend to suffer this pattern of brain injury due to the vulnerability of the immature blood vessels near the lateral ventricles in the brain. These vessels are particularly vulnerable to disruption and bleeding in babies who have not reached term (more than 37 weeks gestation).

In the medical management of preterm labour, obstetrical care providers must have the risk of this injury in mind when making care decisions. Although some medical literature describe PVL as an injury associated with prematurity, PVL does not occur spontaneously – there must be a trigger that leads to the pattern of injury. The mechanism of injury for these premature babies may be the same as that in term babies, but term babies tend to see injury to other locations in the brain because the affected vessels have matured in the term baby.

What is PVL?

Any process that causes impaired fetal oxygenation in the preterm fetus has the potential to cause PVL. This includes birth asphyxia. PVL can occur during pregnancy, during labour or shortly after birth.

PVL most commonly affects fetuses at or before 36 weeks in gestational age. Having said that, most babies born after 30 weeks gestational age do very well, with very few suffering any neurological injury unless some other harmful process initiates this type of injury. The harmful process that initiates PVL is, in some cases, medical error.

Symptoms of PVL.

Depending on the severity and location of the brain damage, a child may have no symptoms or experience significant disability. Symptoms often become more apparent over time and tend to be pronounced by six to nine months of age. They may include:

• spastic diplegia.
• cerebral palsy.
• developmental delays (mental and physical).
• poor coordination.
• vision problems and difficulty with eye movement.
• hearing loss.
• cognitive impairment and learning disabilities.
• developmental delay (mental and physical).
• scoliosis.
• seizures.
• urinary incontinence.

Diagnosing PVL.

Like any neurological injury, PVL will be diagnosed using imaging of the newborn brain. The easiest and most convenient imaging is done using head ultrasound. This modality of imaging, however, is not precise. The gold standard for imaging of the brain is MRI. MRI provides an exquisitely detailed view of the brain lesions associated with acute perinatal injury.

Treatment.

There is no cure for PVL, but certain treatments and therapies can help with symptom management. The type of treatment recommended will depend on an infant’s age, the severity of the condition, and how well medications and therapies are tolerated. Common treatments include:

• physical therapy.
• occupational therapy and assistive devices.
• speech-language therapy.
• vision therapy.

Early intervention with a developmental specialist can often improve outcomes; however, in severe cases a child with PVL may require attendant care and be unable to ever live independently.

Why my child?

Learning that your child has PVL can be devastating - particularly if the damage looks as though it will seriously reduce quality of life or require significant and expensive resources to support them as they grow and live their best life possible. But if you believe a medical provider’s negligence caused or contributed to the condition, it can be especially frustrating. We trust our doctors, nurses, and institutions to care for us and our loved ones in a way that helps, not hurts.

Discovering medical malpractice may have caused your child’s PVL could make you feel angry, sad, overwhelmed and any number of other complex emotions. Above all, you may feel terribly alone in this.

Fortunately, there are many people out there who can support you and your loved one during these difficult times. Gluckstein’s experienced birth trauma lawyers are here to help you and advocate for your child with PVL. As one of Canada’s Top 10 personal injury firms, we have the knowledge, skill, and experience to represent your interests in a civil action against those who hurt you.

How Gluckstein Personal Injury Lawyers Can Help.

When you first contact us for a no cost, no obligation initial consultation, we will listen to your story with great empathy and attention. If you believe your loved one’s PVL injury may have been caused through medical negligence, we will explain how we will conduct a preliminary investigation to determine

if you have an actionable case. If you choose us as your legal representative, we will draw on our extensive network of medical experts as we build a strong case that will encourage a fair and just settlement or be court ready if we need to go to trial. We will also never accept payment unless we are successful in obtaining a settlement or court award for you.

At Gluckstein, we treat our clients as we would treat our own family. That means we care about you and your well-being beyond the legal case. Our renowned team of client liaisons, some of whom had experienced their own personal injuries, will be available to you every step of the way. They will not only update you on the case and provide important information, but also help to connect you with resources or support groups that may help you and your loved ones on your healing journey.

Even when your case ends, our interest in you doesn’t. Many of our past clients will tell you that the relationship they built with us during this exceedingly difficult time of their life has lasted long after they’ve needed our services. It is a privilege to see how the compensation sought for you has helped you and your loved ones live your best life possible.

Trust the team at Gluckstein Personal Injury Lawyers with your PVL birth injury case. Together, we can work to get you what you and your loved ones need and deserve for the harm that was done to you.