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NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 329-330

Dilated Virchow–Robin spaces on MRI: Differential diagnosis ranging from benign to pathological entities


Department of Life, Health and Environmental Sciences, University of L'Aquila; Allergy and Clinical Immunology Unit, AUSL 04 Teramo, Italy

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Massimo De Martinis
Department of Life, Health and Environmental Sciences, University of L'Aquila Via Vetoio 2 Coppito L'Aquila
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253585

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How to cite this article:
Sirufo MM, Ginaldi L, De Martinis M. Dilated Virchow–Robin spaces on MRI: Differential diagnosis ranging from benign to pathological entities. Neurol India 2019;67:329-30

How to cite this URL:
Sirufo MM, Ginaldi L, De Martinis M. Dilated Virchow–Robin spaces on MRI: Differential diagnosis ranging from benign to pathological entities. Neurol India [serial online] 2019 [cited 2019 May 21];67:329-30. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/329/253585




A 48-year-old man presented with a history of severe headache since several years. Investigation with magnetic resonance imaging of the brain showed multilobular cysts with gliosis at places, located predominantly in the left hemisphere in the subcortical frontoparietal cerebral white matter in the centrum semiovale, in the temporal lobe, in the insula in the basal ganglia, and to a lesser extent, in the contralateral hemisphere [Figure 1], [Figure 2], [Figure 3]. The multiple confluent well-defined lesions were isointense to cerebrospinal fluid on coronal T2-weighted images [Figure 2]. Carefully listening to the history, we discovered that since 2002, he was referred to different specialized centers throughout the country where an MR study of the brain was performed and then he underwent further investigations to exclude a mucopolysaccharidosis (skin biopsy and notch 3 gene – cadasil) and a parasitic disease (cysticercosis). Actually, the lesions clearly visible at the magnetic resonance imaging of the brain are enlarged perivascular spaces, the Virchow–Robin spaces. They are usually incidental findings (with a prevalence rate of 1.6–3% in healthy individuals) sometimes associated with neurological symptoms.[1] Several congenital, vascular, infectious and neoplastic processes could be confused with dilated perivascular spaces.[2],[3] The etiology of enlargement of the spaces is still matter of debate; fibrosis and obstruction of lymphatic drainage pathways, myelin loss, ex-vacuo dilatation secondary to brain atrophy, or alterations of arterial wall permeability are some of the proposed pathogenic mechanisms.[1],[4]
Figure 1: Axial MR images showing multiple well-defined rounded areas of various sizes mainly in the left frontal region

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Figure 2: Coronal MR images showing the well-defined rounded cystic areas with signal intensity identical to that of cerebrospinal fluid, with no mass efect and no perilesional edema

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Figure 3: Sagittal MR images showing the multiple cystic areas

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mohan S, Verma A, Sitoh YY, Kumar S. Virchow-Robin spaces in health and disease. Neuroradiol J 2009;22:518-24.  Back to cited text no. 1
    
2.
Rudie JD, Rauschecker AM, Nabavizadeh SA, Mohan S. Neuroimaging of dilated perivascular spaces: From benign and pathologic causes to mimics. J Neuroimaging 2018;28:139-49.  Back to cited text no. 2
    
3.
Husøy AK, Indergaard MK, Honningsvåg LM, Håberg AK, Hagen K, Linde M, Gårseth M, Stovner LJ. Perivascular spaces and headache: A population-based imaging study (HUNT-MRI). Cephalalgia 2016; 36:232-9.  Back to cited text no. 3
    
4.
Jhawar SS, Garewal SS, Bhargava P, Nittala SP. Dilated Virchow Robin spaces mimicking cystic neoplasm of cingulated gyrus. Neurol India 2012;60:136-7.  Back to cited text no. 4
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