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NEUROIMAGE
Year : 2012  |  Volume : 60  |  Issue : 1  |  Page : 136-137

Dilated Virchow Robin spaces mimicking cystic neoplasm of cingulated gyrus


1 Department of Neurosurgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Radiodiagnosis, Christian Medical College and Hospital, Ludhiana, Punjab, India, India

Date of Web Publication7-Mar-2012

Correspondence Address:
Sukhdeep S Jhawar
Department of Neurosurgery, Christian Medical College and Hospital, Ludhiana, Punjab - 141008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.93595

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How to cite this article:
Jhawar SS, Garewal SS, Bhargava P, Nittala PP. Dilated Virchow Robin spaces mimicking cystic neoplasm of cingulated gyrus. Neurol India 2012;60:136-7

How to cite this URL:
Jhawar SS, Garewal SS, Bhargava P, Nittala PP. Dilated Virchow Robin spaces mimicking cystic neoplasm of cingulated gyrus. Neurol India [serial online] 2012 [cited 2019 Oct 15];60:136-7. Available from: http://www.neurologyindia.com/text.asp?2012/60/1/136/93595


A 45-year-old male presented with history of severe headache since two months. He was investigated and brain magnetic resonance imaging (MRI) showed a multiloculated cystic lesion involving left cingulated gyrus [Figure 1] and [Figure 2]. Lesion was well-defined and extending up to the corpus callosum [Figure 3]. The lesion showed no calcifications, hemorrhage, enhancement or perilesional edema. Diffusion-weighted images showed no restricted diffusion. Considering the atypical location and appearance on MRI, a histopathological correlation was planned. Patient underwent neuroendoscopic interhemisperic biopsy of cyst wall. The cystic areas were histologically confirmed to be enlarged perivascular spaces.
Figure 1: Axial T1-weighted magnetic resonance image showing a well-defined multiloculated cystic lesion in the left cerebral hemisphere. There is no perilesional edema seen. No solid component is noted within this lesion

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Figure 2: Coronal T2-weighted image shows the multiloculated cystic lesion in the left cingulated gyrus

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Figure 3: Sagittal T2-weighted image showing the cystic lesion involving the cingulate gyrus with indentation of the body of the corpus callosum

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Virchow-Robin (VR) spaces surround the walls of vessels as they course from the subarachnoid space through the brain parenchyma. Dilated VR spaces typically occur in three characteristic locations: Type I VR spaces found along the lenticulostriate arteries entering the basal ganglia; Type II VR spaces found along the paths of perforating medullary arteries as they enter the cortical gray matter over the high convexities; and Type III VR spaces in the midbrain. Occasionally, VR spaces appear markedly enlarged, cause mass effect, and assume bizarre cystic configurations. [1] Knowledge of the signal intensity characteristics and locations of VR spaces helps differentiate them from various pathologic conditions, including cystic tumors, parasitic cysts, cystic infarctions, non-neoplastic neuroepithelial cysts, cystic periventricular leukomalacia, multiple sclerosis, mucopolysaccharidoses, and arachnoid cysts. [1] Rarely, as seen in the present patient, they can also occur at an atypical location causing diagnostic confusion. In such cases, neuroendoscopic biopsy offers a safe effective treatment option. [2]

 
  References Top

1.Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics 2007;27:1071-86.  Back to cited text no. 1
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2.Rohlfs J, Riegel T, Khalil M, Iwinska-Zelder J, Mennel HD, Bertalanffy H, et al. Enlarged perivascular spaces mimicking multicystic brain tumors. Report of two cases and review of the literature. J Neurosurg 2005;102:1142-6.  Back to cited text no. 2
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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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