periventricular leucomalacia, help interpreting please

[nastursim]

My 17 month old daughter has been suffering with hypotonia since birth and has been diagnosed with mild cerebral palsy. Recently she had an MRI performed and the report is all jibberish to me, and I was wondering if someone could help interpret it for me.
"Myelination appears slightly delayed for the patient's age with relatively high signal in the region of the arouate fibres in the occipital lobes on FLAIR and T2 weighed imaging. The cerebral sulci and sylvian fissures appear slightly prominent consistent with relative reduction in white matter volume. The features are consistent with delayed myelination, particularly posteriorly. The features are nonspecific and the differential diagnosis includes pervientricular leucomalacia"

What the heck does all this mean really, apart from being told she has mild CP and hypotonia it doesn't give me and specific area of injury and what parts of her life it will affect. Could anyone please help?

[Quixotic1]

As a pediatrician I worked with children with this type of problem for 19 years on the South Side of Chicago.  I hope I can help.

The MRI shows signs that there has been damage to the white matter of the brain.  Injury to the brain such as might be seen with lack of oxygen, low blood sugar, intra utero stroke, metabolic problems, hemorrhages - all different kinds of injury can lead to delayed myelinization of the nerves in the brain.  That is they have not matured or developed completely.

Periventricular leukomalacia means a lessening in the amount of brain matter in the areas of the brain around the ventricles.  This is often seen in premies or babies who have had an intracranial bleed.  Did she have problems shortly after birth?

The last comment about the sulci and folds in the surface of the brain "being a little prominent" indicates that the brain is not quite filling the inside of the skull.  There is a little less brain tissue than we would expect.  This was especially true in the posterior part of her brain, the occipital part.  This is the area which handles vision.  

I  wish I could answer your most basic question.  What does the future hold for her?  Nobody can answer this.  She already shows some damage and delay, but her ultimate person can't be predicted.  Kids with brain damage often surprise us with their capacity to adapt and learn - much more so than adults with similar injury.

What her parents and her pediatrician need to do is give her every opportunity to overcome what she can.  She needs a good pediatric neurologist, a thorough exam by a pediatric opthalmologist, hearing tests and intensive work with pediatric trained physical therapist, speech and language therapy and occupational therapists.  The earlier the intervention, the better the outcome.  You must all be her best and most active activists.

She would benefit from a 0-to-3 Program which often provides all or some of the assessments mentioned above.

You may already be hooked into such a comprehensive team.  If so, great!  Feel free to ask more questions.  Quix

[nastursim]

My daughter wasn't premmie, she was induced 24 hours after my waters breaking. SHe lost my than 1/3 of her birth weight, and after going home I was told she was suffering with jaundice. For the first month of her life she basically slept, I had to try and wake her every 1 to 2 hours to feed her as she wasn't gaining weight and not interested in feeding, and very difficult to wake up. She didn't smile at 6 weeks, didn't role over until she was 7 months old, commando crawled at 8 months, sat at 10 months, crawled properly at 11.5 months, and walked at 16 months. She began physio at 6 months of age by recommendation of the clinic sister. Ever since then she has been involved in an early intervention programmme with the physio and speech therapist. She has responded just wonderfully to all their therapy and I am amazed at her determination to get to where she wants to. She will focus on one particular skill until she has mastered it. She still has signs of low muscle tone, and her left side tends to lag behind the right. I worry about her slouching as she tends to sit on the back of her trunk, and her little fingers are VERY weak. I have not noticed any problems with her vision, although lately she did go backwards and seemed to forget her words. I am going to get her hearing checked next month and she will undergo a genetics review also.

What part of the body's development does the white matter affect? I was told it was her motor skills, but is there more to it? WIll it degenerate?

SHe is an absolutley beautiful little soul, and to look at she appears to be normal, although it has taken so many appointments to get her this far. I am thankful that her brain does seem to be in some way "healing" and I do really feel for others her are not so fortunate to have such results.

[Quixotic1]

I'm not in my area of comfortable knowledge talking about the exact interpretations of the MRI.  In all honesty, in practice I left the interpretating to my neurologists because I was so busy and the MRI was in such rapid development and evolution in the 80's and 90's.

I think that with the problems that the MRI shows now "What you have is what you get."  Those should be static lesions.  I do not believe that they indicate anything that will degenerate or become worse in terms of the brain itself.  Those areas of PVL will not REgenerate as that does not happen in the human brain.  The baby's brain though is still developing, and they can work new pathways around areas of injury and still acquire new skills.  So I NEVER make dire predictons.  She needs every opportunity to develop everything she has.  It sounds like you're really there helping her.  Her response to therapy sounds wonderful!

Do they think they know why the brain damage?

Quix

[nastursim]

The reason for the brain damage is a mystery to us all. It is thought that maybe it was due to my having the flu during my 5th month, but it is only a guess. I did take medication during my pregnancy but that never affected any of my other children. Just one of those things. I do wonder though if it had to do with her jaundice, but I guess we will never really know.