Prematurity is Most Strongly Supported by Periventricular Leukomalacia
Prematurity (Option C) is the most strongly supported finding by a diagnosis of periventricular leukomalacia, as it represents the primary risk factor and underlying pathophysiological mechanism for developing this condition. 1
Understanding the Relationship Between PVL and Prematurity
The diagnosis of periventricular leukomalacia fundamentally implies prematurity as the central etiologic factor:
Prematurity is the most strongly associated factor with PVL, representing both the primary risk factor and the underlying pathophysiological mechanism for developing this condition 1
The incidence of severe periventricular hemorrhagic infarction reaches 30% in infants born at 22 weeks and decreases to 3% at 28 weeks gestational age, demonstrating the direct relationship between degree of prematurity and PVL risk 1
PVL is specifically defined as a term reserved to describe white matter injury in the premature brain 2
The topography of PVL lesions reflects the relatively immature cerebrovasculature combined with perfusion failure during the greatest period of vulnerability occurring around mid-to-late gestation 3
Why the Other Options Are Consequences, Not Defining Features
Bilateral Lower Limb Spasticity (Option B)
While the scissoring gait pattern is pathognomonic of bilateral lower limb spasticity (spastic diplegia) 4, this represents a clinical manifestation of PVL rather than what the diagnosis most strongly supports 1
Bilateral lower limb spasticity is a consequence of the condition, not the underlying cause 1
Static Motor Delay (Option A)
Static motor delay is an outcome of PVL, but it represents a broad category that could result from many conditions 1
This is too nonspecific to be what the diagnosis "most strongly supports"
Periventricular White Matter Changes on MRI (Option D)
This option is circular reasoning—the MRI finding is the diagnosis itself, not something supported by the diagnosis 5
The question states "MRI reveals periventricular leukomalacia," so this cannot be what is "supported by" the diagnosis
Clinical Context
The key distinction is that prematurity is the etiologic factor that PVL diagnosis implies, while the other options are either consequences (spasticity, motor delay) or the diagnostic finding itself (MRI changes). 1
Additional important considerations:
43% of infants with cystic PVL also have intraventricular hemorrhage, requiring monitoring for both conditions 1
Bilateral cystic PVL specifically predicts nonambulant cerebral palsy with more severe motor impairment 1
Factors predisposing to PVL include birth trauma, asphyxia, respiratory failure, cardiopulmonary defects, and premature birth/low birthweight 3