Boy Who had a Brain Bleed During Birth that Caused Periventricular Leukomalacia (PVL) & Cerebral Palsy Gets Groundbreaking Operation Called Selective Dorsal Rhizotomy (SDR)

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Selective dorsal rhizotomy (SDR) is a groundbreaking surgical procedure that can help children with cerebral palsy learn to walk.  A four year-old boy named William who has periventricular leukomalacia (PVL) and cerebral palsy recently underwent the very expensive surgery after friends and family raised the money for the operation as well as William’s trip to the U.S.

William has had periventricular leukomalacia and spastic quadriplegic cerebral palsy since birth after he experienced a birth injury that caused his brain to be deprived of oxygen for too long.  William was born 3 months premature.  During delivery, he experienced a traumatic head injury that caused a brain bleed called an intraventricular hemorrhage (IVH).  William had to stay in the NICU for 3 months.

William underwent blood transfusions and was given numerous medications and tests and he defied all odds to become a bright, loving, chatty little boy.  Although William’s mind is moving forward, he is trapped inside a body that is affected by severe spasticity.  His muscles don’t work together, and he has involuntary contractions of muscles that cripple him and relegate him to a wheelchair.  The periventricular leukomalacia (PVL) and cerebral palsy make William dependent on his mother for every move.  William is in pain a lot, despite the constant physical therapy and stretches he does several times a day to help keep his tight muscles as mobile and supple as possible.

Today, William is resting in a hospital bed after undergoing SDR.  The bright-eyed boy is very excited for his future.  He knows that recovery from the surgery will be a long road filled with very aggressive physical therapy, but he can’t wait for the day when he can try to take his first steps.


Selective dorsal rhizotomy (SDR) is a neurosurgical technique used to treat spasticity (increased muscle tone) in the lower limbs.  The lower vertebrae are opened to reveal the spinal cord which contains the neurons of the central nervous system.  These bundles of nerve fibers channel messages between the brain and different areas of the body.  Electrical stimulation is used to identify and sub-divide sensory and motor nerves.  This process continues until the specific nerves and nerve roots causing the muscle spasticity are identified and cut.  After surgery, only the “good” nerves are left.  Many months of physical therapy are needed after the surgery to retrain the legs.


Spastic cerebral palsy is the most common type of cerebral palsy.  Normally, muscles coordinate in pairs; when one group of muscles contract (tighten), the other group relaxes.  This allows free movement.  In spastic cerebral palsy, complications in brain-to-nerve-to-muscle communication occur and the balanced degree of muscle tension is disrupted.  Muscles affected by spastic cerebral palsy become active at the same time, which effectively blocks coordinated movement.  Thus, the muscles in children with spastic cerebral palsy are constantly stiff or spastic.

The main difference between spastic diplegia (spastic cerebral palsy that primarily affects the lower body) and normal body movement is the scissor gait.

Scissor gait is characterized by the following:

  • Hips and pelvis are often locked, as if crouching while walking
  • Knees and thighs may cross or touch while walking
  • Ankles may be turned in while walking
  • Arms and hands may go out from the body to provide balance
  • “Tip toe” walking

The following conditions can cause spastic cerebral palsy:


Periventricular leukomalacia (PVL) is a brain injury primarily seen in premature babies, although term babies can develop PVL after experiencing an insult to the brain.  PVL consists of death and damage of the brain’s white matter, especially near the ventricles.  In some cases of PVL, fluid-filled cysts are left behind when the white matter dies.

Lack of oxygen (hypoxia), and too little blood (ischemia) to the brain are the main causes PVL injuries.  PVL can develop during birth due to birth injuries such as trauma, hypoxia and ischemia, and it can occur after birth, due to hypoxia / ischemia.

A brain bleed called an intraventricular hemorrhage (IVH) is a birth injury that can cause periventricular leukomalacia.  IVH is bleeding inside the brain’s ventricles.  This bleeding can be caused by a lack of oxygen to the baby’s brain and brain trauma.  Premature babies are more susceptible to IVH because blood vessels and other parts of their brains are fragile.  Oxygen deprivation can cause bleeding because when the brain receives insufficient oxygen, cells start to degrade.  When the cells that make up the blood vessel walls start to break down, the vessels become fragile and can rupture very easily.  Traumatic head injury is often caused by the use of forceps and vacuum extractors to assist with delivery.  These devices are placed directly on the baby’s head when the baby is in the birth canal and they place the baby at a significant risk of having a brain bleed.

As with any brain bleed, an intraventricular hemorrhage can damage the brain by causing a decreased amount of oxygen-rich blood in certain areas.  If recognized right away and properly managed, IVH may cause no permanent injury in the baby.  If not properly managed, however, the hemorrhage can cause oxygen deprivation in the brain and the bleed may also extend into other areas of the brain, which can cause periventricular leukomalacia and hydrocephalus.


Of course, the best way to prevent premature birth complications is to prevent preterm birth from occurring.  Being born prematurely poses many risks for a baby.  Because their organs are not fully developed, preterm babies are at risk of experiencing birth injuries such as hypoxic ischemic encephalopathy (HIE), intrventricular hemorrhages (brain bleeds), sepsis, meningitis, periventricular leukomalacia (PVL), cerebral palsy, seizures, intellectual disabilities, and hydrocephalus.

Indeed, premature babies are susceptible to intraventricular hemorrhages, and these types of bleeds can result from physical trauma during birth.  If a baby is in a difficult position, such as a breech presentation, the head may get stuck in the birth canal, or the process of maneuvering the baby might injure the head and cause a bleed.  In a difficult birth, physicians may utilize delivery instruments, such as forceps.  When used improperly, these can cause intracranial hemorrhages.  Indeed, a premature birth makes a breech more likely, and the difficulty of labor can cause the baby to experience head trauma, a brain bleed, a lack of oxygen to her brain and fetal distress.

Physicians must promptly identify risk factors in the mother for premature birth and make every effort to prevent her baby from being born preterm.  Progesterone and cervical cerclage are effective treatments used to help prevent preterm birth in mothers at risk.  When a mother does go into labor prematurely, the physician can give her a medication called a tocolytic to temporarily stop the contractions.  This does not eliminate the condition that is causing the preterm labor, however, but it will delay delivery for approximately 48 hours so that Betamethasone steroids can be given to the mother to help the baby’s lungs (and other types of tissue) mature.

Magnesium sulfate is another medication that should be given if a baby is about to be born prematurely.  This drug can be administered in utero to help protect the baby’s brain and prevent the neurological impairments for which premature babies are at risk.  After birth, surfactant must usually be given to a premature baby to help his lungs mature.


Award winning birth injury lawyers helping children affected by periventricular leukomalacia (PVL) and cerebral palsyIf you are seeking the help of a birth injury lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases.  Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for almost 3 decades.  Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy.  Jesse and his partner, Rebecca Walsh, are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation.  The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

If your child was diagnosed with a birth injury, such as periventricular leukomalacia (PVL), cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help.  We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case.  Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation.  Our firm’s award winning lawyers are available 24 / 7 to speak with you.


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