Psychiatric Manifestations in a Child with Periventricular Leukomalacia: A Case Report and Literature Review

Dr. Parinda Parikh; Ananya Reddy Dadem; Dilinuer Wubuli; Eric Wang; Shaurya Kumar Singh; Himani J Suthar; Kanuja Sood; Arushi Chandra-Kaushik; Rithika Narravula; Sahia Manepalli; Henny Witriol; Dr. Mina Oza

doi:10.23958/ijirms/vol10-i08/2107

Abstract

Background and Objectives: Periventricular Leukomalacia (PVL) is a type of brain injury that involves damage to the white matter around the brain’s fluid-filled ventricles. PVL is more commonly reported in premature infants, and existing studies have associated it with neurodevelopmental sequelae, but its role in behavioral disorders and mood dysregulation in children has not yet been elucidated. This research article aims to evaluate the psychiatric effects of PVL using both pre-existing literature and a clinical case study. Methods: A qualitative investigation of English-language literature published after the year 2000 was performed in PubMed and Google Scholar using the following keywords: periventricular leukomalacia, behavioral disorder, attention deficit and hyperactivity disorder (ADHD), anxiety disorders, and disruptive mood dysregulation disorder. No preference was given. All available literature, including case reports, extensive cohort studies, and mechanistic papers providing insight into PVL pathophysiology, were reviewed, analyzed, and collected. Case Presentation: We report a rarely documented case of a 10-year-old female with PVL presenting with frequent outbursts of aggressive behavior, persistent irritability, refusal to sleep, enduring anxiety, depressed mood, and suicidal ideation. Collateral history reveals that symptoms have been prevalent for a significant period and have progressively worsened. Results and Conclusion: This case illuminates the possibilities of pediatric patients with PVL developing mood and behavioral disorders, emphasizing the need for a multidisciplinary assessment and long-term psychiatric monitoring.

Keywords

periventricular leukomalaciabehavioral disorderattention deficit and hyperactivity disorder (ADHD)anxiety disordersand disruptive mood dysregulation disorder

References

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[refR-2] Kato, A., Ibara, S., Maruyama, Y., & Terahara, M. (2010). Relationship between enlargement of the lateral ventricle and periventricular leukomalacia in infants. The journal of obstetrics and gynaecology research, 36(5), 984–990. https://doi.org/10.1111/j.1447-0756.2010.01290.xDOI ↗Google Scholar ↗

[refR-3] Song, J., Yue, Y., Sun, H., Cheng, P., Xu, F., Li, B., Li, K., & Zhu, C. (2023). Clinical characteristics and long-term neurodevelopmental outcomes of leukomalacia in preterm infants and term infants: a cohort study. Journal of neurodevelopmental disorders, 15(1), 24. https://doi.org/10.1186/s11689-023-09489-7DOI ↗Google Scholar ↗

[refR-4] Pascal, A., de Bruyn, N., Naulaers, G., Ortibus, E., Hanssen, B., Oostra, A., de Coen, K., Sonnaert, M., Cloet, E., Casaer, A., D'Haese, J., Laroche, S., Jonckheere, A., Plaskie, K., van Mol, C., Bruneel, E., van Hoestenberghe, M. R., Samijn, B., Govaert, P., & Van den Broeck, C. (2023). The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study. The Journal of pediatrics, 262, 113600. https://doi.org/10.1016/j.jpeds.2023.113600DOI ↗Google Scholar ↗

[refR-5] Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. 3, DSM-5 Child Mental Disorder Classification. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/Google Scholar ↗

[refR-6] Mamtani, H., Shiva, L., Nanjundaswamy, M. H., Kamble, N., Prasad, C., Desai, G., Chandra, P. S., & Thippeswamy, H. (2022). Treatment resistance in bipolar affective disorder with recurrent mania course-Role of periventricular leukomalacia. Bipolar disorders, 24(1), 93–96. https://doi.org/10.1111/bdi.13138DOI ↗Google Scholar ↗

[refR-7] Choi, J. Y., Rha, D. W., & Park, E. S. (2016). The Effects of the Severity of Periventricular Leukomalacia on the Neuropsychological Outcomes of Preterm Children. Journal of child neurology, 31(5), 603-612. https://doi.org/10.1177/0883073815604229DOI ↗Google Scholar ↗

[refR-8] McQuillen, P. S., & Ferriero, D. M. (2005). Perinatal subplate neuron injury: implications for cortical development and plasticity. Brain pathology (Zurich, Switzerland), 15(3), 250–260. https://doi.org/10.1111/j.1750-3639.2005.tb00528.xDOI ↗Google Scholar ↗

[refR-9] Deng, W., Pleasure, J., & Pleasure, D. (2008). Progress in periventricular leukomalacia. Archives of neurology, 65(10), 1291–1295. https://doi.org/10.1001/archneur.65.10.1291DOI ↗Google Scholar ↗

[refR-10] Hwang, W. J., Kwak, Y. B., Cho, K. I. K., Lee, T. Y., Oh, H., Ha, M., Kim, M., & Kwon, J. S. (2021). Thalamic Connectivity System Across Psychiatric Disorders: Current Status and Clinical Implications. Biological psychiatry global open science, 2(4), 332–340. https://doi.org/10.1016/j.bpsgos.2021.09.008DOI ↗Google Scholar ↗