의학 자료실 Periventricular leukomalaciaPVL 자료실 뇌실주위백질연화증에 관해
[의학] Periventricular leukomalacia[PVL] 뇌실주위백질연화증에 관해
Periventricular leukomalacia (PVL) 뇌실주위백질연화증
1. Background
1) most common ischemic brain injury in premature infants
2) ischemia :동맥혈관분포의 끝 가장자리부분
3) lateral ventricles에 인접한 백색질에
5) cranial ultrasonography뇌신경초음파검사 : periventricular echodensities or cysts낭
6) develop cerebral palsy (CP), intellectual impairment, or visual disturbances.
2. Pathophysiology
1) 혈관손상으로 인한 periventricular area의 심한 손상
2) 세포질분열시 모성의 융모양막염이나 혈관염 때문에 발달하고 있는 뇌실주위에 염증성 손상을 입힘
3. 정의
- bilateral white matter les...Periventricular leukomalacia (PVL) 뇌실주위백질연화증
1. Background
1) most common ischemic brain injury in premature infants
2) ischemia :동맥혈관분포의 끝 가장자리부분
3) lateral ventricles에 인접한 백색질에
5) cranial ultrasonography뇌신경초음파검사 : periventricular echodensities or cysts낭
6) develop cerebral palsy (CP), intellectual impairment, or visual disturbances.
2. Pathophysiology
1) 혈관손상으로 인한 periventricular area의 심한 손상
2) 세포질분열시 모성의 융모양막염이나 혈관염 때문에 발달하고 있는 뇌실주위에 염증성 손상을 입힘
3. 정의
- bilateral white matter lesion
- hypotension, ischemia, and coagulation necrosis응고성 괴사 at the border or watershed zones of deep penetrating arteries of the middle cerebral artery
- Decreased blood flow affects the white matter at the superolateral borders of the lateral ventricles
- 영향 : descending corticospinal tracts, visual radiations, and acoustic radiations
- mechanical ventilation may develop hypocarbia저탄산증
- edema fluid and hemorrhage 백색질의 소동맥을 압박
- 심혈관계 자기조절작용 손상
- intracranial hemorrhage (ICH)
- PVL and ICH detected on ultrasonography
4. Frequency:
1 In the US: Incidence of PVL ranges from 4-26% in premature infants in neonatal intensive care units (NICUs). As many as 75% of premature infants have evidence of PVL on postmortem사후 examination.
5. Mortality/Morbidity:
1 Cerebral palsy: Approximately 60-100% infants with PVL later develop signs of CP. Spastic diplegia is the most common form of CP following mild PVL. Severe PVL is frequently associated with quadriplegia.
2 Intellectual impairment: Varying degrees of intellectual impairment, developmental impairment, or both have been reported in association with PVL.
3 Visual dysfunction: Fixation difficulties, nystagmus, strabismus, and blindness
6. Age: premature infants younger than 32 weeks` gestation at birth.
7. History
32 weeks` gestation
less than 1500g birth weight
cardiorespiratory problems : pneumonia
8. Physical
1 Decreased tone in lower extremities
2 Increased tone in neck extensors
3 Apnea무호흡 and bradycardia서맥
4 Irritability성급함
5 Pseudobulbar palsy with poor feeding
가성구마비(假性球痲痺):연수의 상해로 인한 것이 아니라, 그보다 위쪽 부위의 상해, 즉 내포(內包) 기저핵(基底核) 교부(橋部) 등의 양측성상해(兩側性傷害)에 의한 것으로, 흔히 뇌출혈 뇌연화 등의 반복이 원인임
1 Clinical seizures (may occur in 10-30% of infants)
9. Causes:
1 Mechanically ventilated premature infants born at less than 32 weeks` gestation are at greatest risk for PVL.
2 Hypotension, hypoxemia저산소혈증, and acidosis산중독 may result in ischemic brain injury and PVL.
3 Marked hypocarbia in ventilated premature infants has been associated with increased risk of developing PVL.
4 Other associated risk factors include the following:
- Placental vascular anastomoses태반혈관문합, twin gestation, antepartum hemorrhage분만전 출혈
- Chorioamnionitis융모양막염 and funisitis
- Maternal cocaine abuse
10. Further Outpatient Care:
1 Developmental follow-up: because of the high association with CP.
11. Deterrence/Prevention:
1 Prevention of premature birth
2 Prior to birth, diagnosing and managing chorioamnionit
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자료출처 : http://www.ALLReport.co.kr/search/detail.asp?pk=11076878&sid=ddangkung&key=
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