Intraventricular haemorrhage and periventricular leukomalacia

Overview & Definition

Intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) are the two signature brain injuries of the preterm infant, and they share a single anatomical stage: the periventricular region, where the fragile germinal matrix vasculature and the vulnerable premyelinating oligodendrocytes of the white matter lie in close apposition to the lateral ventricles. A haemorrhage from the germinal matrix that breaches the ependyma and enters the ventricular system is an IVH; injury to the periventricular white matter itself — whether from ischaemia, inflammation, or the downstream effect of a large haemorrhage — is PVL. [1] [5]

The two are clinically and prognostically intertwined. A large IVH can infarct the adjacent parenchyma (the grade IV lesion), obstruct cerebrospinal fluid pathways to cause post-haemorrhagic hydrocephalus, and trigger the inflammatory cascade that injures white matter. Conversely, the same haemodynamic instability and infection that cause PVL can also rupture the germinal matrix. For the clinician the practical point is that an IVH and a PVL are often found together on the same cranial ultrasound, and the severity of each independently shapes the prognosis a family must be helped to understand. [5] [10]

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