Cystic Periventricular Leukomalacia: A Condition that Became Uncommon in the Premature Neonate, Diagnosed on Transcranial Ultrasound

A preterm neonate was born in our center, as a part of a diamniotic dichorionic twin pregnancy, complicated with placental abruption with need for urgent cesarean section at 26 weeks of gestation. After a difficult neonatal start with respiratory and cardiovascular problems, the neonate safely reached the neonatal intensive care unit. Further work-up and supportive care was continued. Transcranial ultrasound imaging through the anterior fontanel was part of this work-up. Initial examinations were not normal, and showed cystic lesions along the germinal matrix, without hydrocephalus or parenchymal lesions. The findings were highly suggestive of sequellae of grade II germinal matrix bleed according to Papile and Burstein (Image A). Further follow-up examinations by means of ultrasound depicted a discrete enlargement of the lateral ventricles over time (Image B). Later on development of widespread periventricular cystic lesions became apparent (Image C and D). The cystic lesions are located in the periventricular white matter, and are not attached to the ventricles. This finding makes cystic periventricular leukomalacia the preferred diagnosis, and makes venous infarction with cystic alterations secondary to germinal matrix bleeding less likely.