Giant cystic Virchow-Robin spaces with adjacent white matter signal alteration

Turk Neurosurg. 2011;21(2):235-8. doi: 10.5137/1019-5149.JTN.2848-09.0.

Abstract

Perivascular spaces surround the small arteries and veins as they enter into the brain parenchyma from the subarachnoid spaces. Also called as Virchow-Robin spaces, these are prominent in the basal ganglia and high convexity white matter of the elderly. Occasionally VR spaces may get massively enlarged and may mimic a cystic mass lesion. The typical CSF-like signal intensity of the cysts and location on MRI, in the absence of a neurological abnormality help in the diagnosis of the giant VR spaces and thus biopsy is avoided. Typically there is no significant adjacent brain abnormality; however FLAIR images may sometimes reveal perilesional white matter hyperintensity, which may be an indication of gliosis due to the mass effect of the lesion. Such a signal alteration should not deter one from making a diagnosis of giant Virchow-Robin spaces when the rest of the imaging findings are typical. We describe a case of a 50-year-old female with incidental giant Virchow-Robin spaces in the right hemispheric subcortical white matter with adjacent white matter hyperintense signal intensity on T2-weighted and FLAIR images.

Publication types

  • Case Reports

MeSH terms

  • Brain / blood supply*
  • Brain / pathology*
  • Cerebral Arteries / pathology
  • Cysts / complications
  • Cysts / pathology*
  • Female
  • Humans
  • Incidental Findings
  • Leukoencephalopathies / etiology
  • Leukoencephalopathies / pathology*
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Subarachnoid Space / pathology