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Periventricular leukomalacia (PVL) is a form of white-matter brain injury, characterized by the necrosis (more often coagulation) of white matter near the lateral ventricles. [ 1 ] [ 2 ] It can affect newborns and (less commonly) fetuses; premature infants are at the greatest risk of neonatal encephalopathy which may lead to this condition.
Head CT showing periventricular white matter lesions. Leukoaraiosis is a particular abnormal change in appearance of white matter near the lateral ventricles. It is often seen in aged individuals, but sometimes in young adults. [1] [2] On MRI, leukoaraiosis changes appear as white matter hyperintensities (WMHs) in T2 FLAIR images.
CT image showing extensive low attenuation in the right hemispheric white matter due to dilated Type 2 perivascular spaces Axial fat-suppressed T2-weighted MRI image in the same patient as above demonstrating extensive dilated Type 2 perivascular spaces in the right hemisphere Perivascular space is depicted in the inset box.
The finding of bilateral periventricular relatively asymmetrical lesions allied with deep white matter involvement, that may also be present in cortical gray-white matter junction, thalami, basal ganglia, cerebellum, and brainstem suggests an acute demyelination process. [22]
For example, it can be used in brain imaging to suppress cerebrospinal fluid (CSF) effects on the image, so as to bring out the periventricular hyperintense lesions, such as multiple sclerosis (MS) plaques. [1] It was invented by Graeme Bydder, Joseph Hajnal, and Ian Young in the early 1990s. [2]
Hyperintensities are commonly divided into 3 types depending on the region of the brain where they are found. Deep white matter hyperintensities occur deep within white matter, periventricular white matter hyperintensities occur adjacent to the lateral ventricles and subcortical hyperintensities occur in the basal ganglia. [citation needed]
Compression of the brainstem as well as poor perfusion of the periventricular white matter in the prefrontal cortex are also thought to contribute to gait deviations in NPH. [14] Dementia in NPH is most likely caused by ventricular enlargement compressing the calvarium, which further leads to tearing of currently unidentified nerve fibers. [14]
White matter is the tissue through which messages pass between different areas of grey matter within the central nervous system. The white matter is white because of the fatty substance (myelin) that surrounds the nerve fibers (axons). This myelin is found in almost all long nerve fibers, and acts as an electrical insulation.