Prematurity is Most Strongly Associated with Periventricular Leukomalacia
Prematurity (Option C) is the most strongly associated factor with periventricular leukomalacia, representing the primary risk factor and underlying pathophysiological mechanism for developing this condition. 1
Understanding the Clinical Context
The patient presents with:
- Scissoring gait pattern - a pathognomonic sign of bilateral lower limb spasticity (spastic diplegia) 2
- MRI showing periventricular leukomalacia - confirming the diagnosis
- These findings indicate the consequences of PVL, not the underlying association
Why Each Answer Choice Relates to PVL Differently
Option C: Prematurity (CORRECT ANSWER)
- Prematurity is the primary risk factor and most strongly associated factor with PVL 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 occurs predominantly in premature infants due to incomplete vascular development and impaired cerebral blood flow autoregulation during the vulnerable period of mid-to-late gestation 3
- In one study, 24 of 25 children (96%) with PVL were preterm births 4
Option B: Bilateral Lower Limb Spasticity (Clinical Manifestation)
- This is a characteristic clinical manifestation of PVL, but it is a consequence of the condition, not the underlying cause 1
- The scissoring pattern specifically indicates spastic diplegia resulting from the white matter injury 2, 5
- Among children with PVL, 36% develop spastic diplegia and 48% develop quadriplegia 4
Option A: Static Motor Delay (Outcome)
- This is an outcome of PVL, representing a broad category that could result from many conditions 1
- It describes the functional impairment rather than the etiological association
Option D: Periventricular White Matter Changes on MRI (Diagnostic Finding)
- This is the diagnostic finding that confirms PVL, not an associated factor 2
- The MRI changes are the definition of the condition itself, making this a tautological answer
Clinical Pitfalls to Avoid
- Do not assume isolated intraventricular hemorrhage (IVH) when PVL may coexist - 43% of infants with cystic PVL also have IVH, and 13% of infants with IVH also have PVL, requiring different prognostic counseling 1, 6
- Monitor for cerebellar hemorrhage - this co-occurs in 10% of preterm infants with PVL and increases the risk of abnormal neurological outcomes 5-fold 1, 6
- Serial imaging is essential as early changes may be subtle or absent initially 1, 6