Expanding lacunae causing triventricular hydrocephalus

Abstract

Two patients are reported in whom the presence of triventricular hydrocephalus and aqueductal obstruction or stenosis due to multiple expanding lacunae in the mesencephalothalamic region possibly corresponds to abnormally dilated perivascular spaces. Placement of a ventriculoperitoneal cerebrospinal fluid (CSF) shunt in one patient and the performance of a third ventricle cisternotomy in the other reversed the hydrocephalic syndrome, but did not modify the complex neuroophthalmological disturbance and rubral tremor presumably related to the compressive effects of the lacunae on adjacent parenchyma. In one patient the number and size of the lacunae were increased 4 years after CSF shunt placement. A review of the literature revealed two cases in which magnetic resonance imaging demonstrated a similar, poorly understood pathological condition.

Dilated Virchow-Robin Spaces in Myotonic Dystrophy: Frequency, Extent and Significance

“…In some pathological conditions, such as Binswanger’s subcortical arteriosclerotic encephalopathy or ‘expanding lacunae’, the neuropathological demonstration of arteriosclerotic modifications or necrotizing arteritis suggests that alterations of arterial wall permeability may produce the enlargement of VRSs [30]. The term ‘expanding lacunae’ refers to VRSs that may abnormally dilate producing obstructive hydrocephalus [31], dementia [32], temporal lobe epilepsy [33]or even no symptom [34]. Some authors pointed to a possible disorder of brain lymphatic drainage for explaining the expanding character of some VRSs [35].…”

Cystic Dilation of Virchow-Robin Spaces in the Midbrain

“…It has been suggested that they may be the result of altered blood vessel wall permeability due to a vasculitis or lymphatic vessel obstruction [10][11][12]. In several cases, such cystic lesions have been reported in association with aqueduct stenosis [7,8]. We believe that the lesions seen in our case represent dilated Virchow-Robin spaces because of the distribution and signal intensity.…”

Traumatic Intracystic Hemorrhage in a Case with Thalamo-Mesencephalic ‘Expanding Lacunae’: An Uncommon Cause of Sudden-Onset Neurological Signs

“…They are usually characterized by an insidious progressive onset of extrapyramidal, hydrocephalic and midbrain syndromes [1,4,5,7]. They can also be asymptomatic [2], presenting as an incidental autopsy finding.…”

“…The slight concomitant limb ataxia is attributed to a disturbance of the restiform body or afferent spinocerebellar tract. This clinical condition can occur if the posterior spinal artery or an artery of the posterior group of medullary arteries, all branches of the posterior inferior cerebellar artery, are affected [6][7][8]. With increasing use of MRI the identification of the location and extension of small ischemic lesions is possible, allowing a clear-cut correlation between clinical and anatomical findings ( fig.…”

“…

IntroductionBrain intraparenchymal multicystic lesions of the brainstem and basal ganglia are rare and the observation of 'expanding lacunae' (EL) is exceptional: only 8 cases have been described [1][2][3][4][5][6][7]. They are intraparenchymal multilobulated cavities of variable diameter filled with cerebrospinal fluid (CSF) and are mostly localized in the thalamo-mesencephalic region.

…”