Periventricular leucomalacia: a review

Periventricular leucomalacia is a condition that causes lifelong disability and considerable economic burden. It occurs in premature infants of less than 32 weeks gestation due to their unique anatomical features. The white matter of these infants is poorly vascularised and contains oligodendrocyte progenitors (pre-oligodendrocytes), which are sensitive to the effects of ischaemia and infection. Only recently have newer imaging techniques identified both a diffuse and focal component of white matter damage. The most immature infants with diffuse injury develop white matter atrophy and ventriculomegaly; others with focal injury have cyst formation, resorption and gliosis. Since the original description by Virchow in 1867, much progress has been made in establishing the underlying cause of this condition. It is an ischaemia reperfusion injury of the white matter, free radicals being the final pathway to pre-oligodendrocyte destruction and impaired myelination. Contributory factors include hypotension, hypocarbia and infection. Conclusion:new imaging and EEG techniques are likely to improve our ability to predict disability in this vulnerable group of infants. Research is needed into blocking the pathway to pre-oligodendrocyte destruction and the safe use of free radical scavengers.