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

Dilated Virchow Robin spaces mimicking cystic neoplasm of cingulated gyrus

Sukhdeep S Jhawar1, Sarvpreet S Garewal1, Priyanshu Bhargava1, Pramod P Nittala2,  
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

Correspondence Address:
Sukhdeep S Jhawar
Department of Neurosurgery, Christian Medical College and Hospital, Ludhiana, Punjab - 141008
India




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;60:136-137


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 2021 Apr 20 ];60:136-137
Available from: https://www.neurologyindia.com/text.asp?2012/60/1/136/93595


Full Text

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}{Figure 2}{Figure 3}

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

1Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics 2007;27:1071-86.
2Rohlfs 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.