Tumefactive Virchow-Robin spaces

Atypical Virchow-Robin Spaces Mimicking Cystic Primary Brain Tumor – Clinical Report and Literature Review

“…Besides that, the VRS has a specific macrophagic population that might be enrolled with some immunologic functions, even though it has not been well documented. [1][2][3][4]17,20 The enlarged VRS is defined as perivascular spaces wider than 3 mm, which are rarely located on the cortical surface and are often found in the inferior portion of the basal ganglia, Fig. 3 Case 2.…”

“…2 It has been hypothesized a positive correlation between those enlarged VSRs with a wide variety of neurological diseases such as psychiatric disorders, dementia, cognitive disturbances, multiple sclerosis, brain trauma and microvascular anomalies of the brain. [13][14][15][16][17][18][19][20][21] On MRI, the VRS shares similar characteristics to CSF, that is, hypointense signal in T1-and hyperintense signal on T2weighted images. [1][2][3][4][19][20][21][22][23] There is no restriction to diffusion, no gadolinium enhancement, and a suppressed signal on FLAIR sequences.…”

“…[1][2][3][4][19][20][21][22][23] On brain CT, it might be identified as CSF-like cystic lesions, without calcifications or contrast enhancement. [1][2][3][4][19][20][21][22][23] These enlarged VRSs might be classified in three types: Type 1, the lenticulostriate arteries are involved at the level of the basal ganglia and anterior perforated substance; Type 2, if it is located around the medullary veins of the brain, in the superficial cortical region or in the white matter surrounding it; Type 3, when the VRS is located close to the brainstem, around the mesencephalic vessels, especially at the level of the thalamomesencephalic junction. 1,20 When very wide, the VRS are called tumefactive perivascular spaces.…”

“…[1][2][3][4][19][20][21][22][23] These enlarged VRSs might be classified in three types: Type 1, the lenticulostriate arteries are involved at the level of the basal ganglia and anterior perforated substance; Type 2, if it is located around the medullary veins of the brain, in the superficial cortical region or in the white matter surrounding it; Type 3, when the VRS is located close to the brainstem, around the mesencephalic vessels, especially at the level of the thalamomesencephalic junction. 1,20 When very wide, the VRS are called tumefactive perivascular spaces. 7,13,23 A special variant of this, which sometimes can mimic cystic brain tumors, was recently described and named anterior temporal lobe perivascular space.…”

“…Although some contemporary studies have suggested that it might be related to certain traumatic brain injury and several other central nervous system (CNS) disorders, its real meaning is unknown. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Occasionally, some enlarged VRSs can reach a very large volume, assume bizarre settings and have reactional gliosis surrounding them. In these particular conditions they are socalled atypical and tumefactive VRSs and may present themselves with symptoms such as seizures, hydrocephalus and headache.…”