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Almotairi FS, Alanazi AI, Alokayli SH, Maghrabi S, Elwatidy SM. Atypical Presentation of Idiopathic Intracranial Hypertension: A Case Series and Literature Review. Asian J Neurosurg 2024; 19:179-185. [PMID: 38974423 PMCID: PMC11226282 DOI: 10.1055/s-0044-1779447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a condition in which intracranial pressure (ICP) increases without an apparent cause. Typically, patients present with headaches, dizziness, pulsatile tinnitus, visual disturbances, blurred vision, diplopia, photophobia, visual field defects, and papilledema on fundoscopy. The association between IIH, spontaneous cerebrospinal fluid (CSF) rhinorrhea, and arachnoid cysts has been discussed in the literature; however, there is no clear explanation for this association. We aimed to present a series of four patients with a confirmed diagnosis of IIH with atypical presentations, discuss the management of each case, and provide an explanation for this association to alert clinicians to the atypical presentation of IIH and facilitate early diagnosis and proper treatment of this condition by CSF diversion. This was a retrospective case series of all patients who were diagnosed with IIH and showed improvement after ventriculoperitoneal shunt insertion after failure of at least one operative intervention resulting from primary radiological and clinical findings in 2001 to 2022. Data on demographics, clinical presentation, radiological findings, surgical management, and diagnostic criteria for IIH were recorded. We identified four patients with a confirmed diagnosis of IIH who presented with atypical presentations as follows: intracranial arachnoid cyst, cervical spine arachnoid cyst, giant Virchow perivascular space, and spontaneous CSF (CSF) rhinorrhea. All patients responded to CSF diversion after failure of surgical treatment targeting the primary pathology. IIH should be suspected after the failure of primary surgical treatment in cases of spontaneous CSF rhinorrhea, spinal and cranial arachnoid cysts, and symptomatic ventriculoperitoneal shunt. Treatment in such situations should be directed toward IIH with CSF diversion.
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Affiliation(s)
- Fawaz S. Almotairi
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aued I. Alanazi
- Department of surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sherin Hamad Alokayli
- Department of surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sarah Maghrabi
- Department of surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sherif M. Elwatidy
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Khoulali M, Mehfoud I, Mejdoubi A, Khay H, Guini M, Oulali N, Moufid F, Mebrouk Y, Bkyer H, Housni B. Endoscopic Infratentorial Supracerebellar approach for the mesencephalic enlarged Virchow Robin Space fenestration, an alternative minimally invasive route. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Ayyildiz V, Koksal A, Taydas O, Ogul H. Contribution of advanced MRI to the diagnosis of giant tumefactive perivascular spaces. Acta Radiol 2021; 63:1554-1562. [PMID: 34839718 DOI: 10.1177/02841851211047240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Giant tumefactive perivascular spaces (PVSs) are uncommon benign cystic lesions. They can imitate cystic neoplasms. PURPOSE To evaluate the contribution of advanced neuro magnetic resonance imaging (MRI) techniques in the diagnosis of giant tumefactive PVSs and to further characterize these unusual cerebral lesions. MATERIAL AND METHODS The MRI scans of patients with tumefactive PVS diagnosed between 2010 and 2019 were retrospectively reviewed. All imaging studies included three plane conventional cerebral MRI sequences as well as precontrast 3D T1 MPRAGE, post-gadolinium 3D T1 acquisitions, sagittal plane 3D T2 SPACE, diffusion-weighted imaging, and time-of-flight (TOF) angiography. Some patients received perfusion MR, MR spectroscopy, diffusion tensor imaging (DTI), and contrast-enhanced TOF MR angiography. RESULTS A perforating vessel was demonstrated in 16 patients (66.7%) by TOF imaging. In four patients, there were intracystic vascular collaterals on contrast-enhanced TOF MR angiography. Septal blooming was observed in four patients in susceptibility-weighted imaging. On perfusion MR, central hyperperfusion was observed in four patients, and peripheral hyperperfusion was observed in one patient. On MR spectroscopy, choline increase was observed in two patients, and there was a lactate peak in three patients, and both a choline increase and lactate peak in one patient. On DTI, there was fiber distortion in five patients and fiber deformation in one patient. CONCLUSION Advanced MRI techniques and 3D volumetric high-resolution MRI sequences can provide a valuable contribution to the diagnosis and can be successfully used in the management of these lesions.
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Affiliation(s)
- Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Ali Koksal
- Bayindir Private Hospital, Ankara, Turkey
| | - Onur Taydas
- Department of Radiology, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
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Idiculla PS, Gurala D, Siddiqui JH. Giant tumefactive perivascular spaces: an incidental finding. Acta Neurol Belg 2020; 120:1443-1444. [PMID: 32856207 DOI: 10.1007/s13760-020-01481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
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De Schlichting E, Zaldivar-Jolissaint JF, Castrioto A, Reyns N, Chabardès S. Reversible Focal Dystonia Secondary to Giant Perivascular Spaces. Stereotact Funct Neurosurg 2020; 98:80-84. [PMID: 32050205 DOI: 10.1159/000505711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022]
Abstract
Giant perivascular spaces (PVS) are rare, CSF-filled, dilated cavities lined by the pia mater that are most often asymptomatic radiological findings but can sometimes cause neurological symptoms. We present two exceptional cases of secondary focal dystonia induced by the mass effect on the basal ganglia caused by giant diencephalic PVSs. In both cases, we chose a surgical stereotactic drainage approach as a treatment strategy that allowed controlling the movement disorders. The beneficial therapeutic effect was sustained at long-term follow-up. We believe that similar cases could be addressed successfully with this method.
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Affiliation(s)
- Emmanuel De Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), La Tronche, France,
| | | | - Anna Castrioto
- Movement Disorders Center, Neurology, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1216, Grenoble, France
| | - Nicolas Reyns
- Service de Neurochirurgie, Centre Hospitalier Régional Universitaire de Lille (CHRUL), Lille, France
| | - Stephan Chabardès
- Service de Neurochirurgie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), La Tronche, France.,Clinatec, Grenoble, France
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Parish J, McPheeters M, Wait SD. Endoscopic management of benign cystic lesions of the thalamus with fenestrated stent placement. J Clin Neurosci 2019; 67:226-230. [PMID: 31281086 DOI: 10.1016/j.jocn.2019.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/16/2019] [Accepted: 06/09/2019] [Indexed: 11/15/2022]
Abstract
Benign intracranial cystic lesions of the thalamus are an uncommon clinical entity rarely requiring operative decompression. In combination with cyst fenestration, cerebrospinal fluid (CSF) flow diversion or fenestrated stent placement may be performed at the time of surgery. We describe a method of treatment of these cysts using endoscopic cyst fenestration with fenestrated transventricular stent placement. Three patients with benign cystic lesions were treated with stereotactic-guided, endoscopic fenestration and fenestrated stent placement. All 3 had radiographic and clinical improvement. There were no complications. Endoscopic fenestration and transventricular fenestrated stent placement is a minimally invasive, effective, and safe method to decompress benign, symptomatic cystic lesions of the thalamus.
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Affiliation(s)
- Jonathan Parish
- Department of Neurological Surgery, Carolinas Medical Center, Charlotte, NC, United States
| | - Matthew McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Scott D Wait
- Department of Neurological Surgery, Carolinas Medical Center, Charlotte, NC, United States; Carolina Neurosurgery and Spine Associates, Charlotte, NC, United States.
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Kwee RM, Kwee TC. Tumefactive Virchow-Robin spaces. Eur J Radiol 2019; 111:21-33. [DOI: 10.1016/j.ejrad.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/01/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
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Giant Tumefactive Perivascular Spaces: A Case Report and Literature Review. World Neurosurg 2018; 112:201-204. [DOI: 10.1016/j.wneu.2018.01.144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022]
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Woo PYM, Cheung E, Zhuang JTF, Wong HT, Chan KY. A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis. Asian J Neurosurg 2018; 13:1295-1300. [PMID: 30459922 PMCID: PMC6208240 DOI: 10.4103/ajns.ajns_108_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cerebral perivascular spaces (PVSs), otherwise known as Virchow-Robin spaces, are interstitial fluid-filled channels, <2 mm in diameter that form around arterial perforators as they course from the cortex into the brain parenchyma. In contrast, a giant tumefactive PVS is a rare entity comprising of clusters of such channels larger than 15mm resembling a neoplastic process as the name suggests. We report a 55-year-old male who presented with unsteady gait, cognitive decline, and left lower limb weakness for 6 months. Magnetic resonance imaging revealed a noncontrast enhancing multicystic intraaxial lesion of the right mesencephalon-diencephalon junction extending into the anterior third ventricle causing obstructive hydrocephalus. A ventriculoperitoneal shunt was inserted with a complete reversal of his neurological symptoms. Such PVSs can easily be misidentified for a cystic tumor, and their unique radiological features are discussed to prevent unnecessary surgery. We also demonstrate that when they cause hydrocephalus and midbrain compression symptoms cerebrospinal fluid shunting alone can result in excellent outcomes.
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Affiliation(s)
| | - Eric Cheung
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | | | - Hoi-Tung Wong
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Kwong-Yau Chan
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
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López Fernández M, Fraga Bau A, Volkmer García C, Canneti Heredia B. Virchow-Robin spaces: A cause of parkinsonism? NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Kao Y, Hsu SY, Chang CJ, Huang JS. Novel treatment of symptomatic pontine Virchow-Robin space. Kaohsiung J Med Sci 2016; 32:336-7. [PMID: 27377849 DOI: 10.1016/j.kjms.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ying Kao
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shao-Yuan Hsu
- Division of Neurosurgery, Department of Surgery, Taipei City Hospital, Hoping Fuyou Branch, Taipei, Taiwan
| | - Chih-Ju Chang
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Jing-Shan Huang
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.
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13
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Smith KA, Lavin P, Chamoun R. Neuroendoscopic treatment of symptomatic giant Virchow-Robin spaces. Surg Neurol Int 2015; 6:120. [PMID: 26257981 PMCID: PMC4521222 DOI: 10.4103/2152-7806.161240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/22/2015] [Indexed: 12/05/2022] Open
Abstract
Background: Virchow–Robin spaces (VRS) or perivascular spaces are interstitial cystic spaces surrounding the vasculature of brain parenchyma and course from the subarachnoid space. Small VRS (<2 mm) appear in all age groups, but can enlarge and be confused with other lesions like cystic neoplasms. These enlarged VRS are termed giant tumefactive perivascular spaces (GRPVS). Case Description: We present the case of a 50-year-old male who presents with right eye pain, blurred vision, headache, and gait imbalance. He was diagnosed with GRPVS and underwent an endoscopic third ventriculostomy and cyst fenestration. Postoperative imaging showed a decrease in size of the ventricular system with evidence of flow through the aqueduct and ventriculostomy. Brainstem VRS cysts decreased in size. Conclusion: Unlike the other small number of case reports, this patient is unique in his age of presentation and successful endoscopic method of treatment. The endoscopic approach provided great exposure and adequate access to the lesions. Clinically, symptoms improved, cyst size decreased, and need for permanent shunt placement was averted.
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Affiliation(s)
- Kyle Anthony Smith
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Lavin
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Roukoz Chamoun
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
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Zafar N, Alaid A, Rohde V, Mielke D. Intermittent visual field defects caused by a dilated Virchow–Robin space close to the optic radiation: Therapeutic and pathomechanical considerations. Br J Neurosurg 2015; 29:549-51. [DOI: 10.3109/02688697.2015.1019417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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López Fernández M, Fraga Bau A, Volkmer García CM, Canneti Heredia B. Virchow-Robin spaces: A cause of parkinsonism? Neurologia 2015; 31:493-4. [PMID: 25728953 DOI: 10.1016/j.nrl.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/20/2014] [Accepted: 01/07/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- M López Fernández
- Servicio de Neurología, Hospital Comarcal de Valdeorras, Complexo Hospitalario Unversitario de Ourense, Ourense, España.
| | - A Fraga Bau
- Servicio de Neurología, Hospital Comarcal de Valdeorras, Complexo Hospitalario Unversitario de Ourense, Ourense, España
| | - C M Volkmer García
- Servicio de Neurología, Hospital Comarcal de Valdeorras, Complexo Hospitalario Unversitario de Ourense, Ourense, España
| | - B Canneti Heredia
- Servicio de Neurología, Hospital Comarcal de Valdeorras, Complexo Hospitalario Unversitario de Ourense, Ourense, España
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Roelz R, Egger K, Reinacher P. Giant perivascular spaces causing hemiparesis successfully treated by cystoventriculoperitoneal shunt. Br J Neurosurg 2014; 29:100-102. [PMID: 25232805 DOI: 10.3109/02688697.2014.957160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a 55-year-old man affected by a slowly progressive hemiparesis. Imaging revealed giant dilations of brain perivascular spaces, or Virchow-Robin spaces of the thalamo-mesencephalic region and occlusive hydrocephalus. Stereotactic catheter cystoventriculostomy alone reverted hemiparesis. However, conversion of the catheter into a peritoneal shunt system was necessary to treat hydrocephalus.
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Affiliation(s)
- Roland Roelz
- a Department of Stereotactic and Functional Neurosurgery , University Medical Center Freiburg , Freiburg , Germany.,b Department of Neurosurgery , University Medical Center Freiburg , Freiburg , Germany
| | - Karl Egger
- c Department of Neuroradiology , University Medical Center Freiburg , Freiburg , Germany
| | - Peter Reinacher
- a Department of Stereotactic and Functional Neurosurgery , University Medical Center Freiburg , Freiburg , Germany
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Bilginer B, Narin F, Hanalioglu S, Oguz KK, Akalan N. Virchow-Robin spaces cyst. Childs Nerv Syst 2013; 29:2157-62. [PMID: 23896867 DOI: 10.1007/s00381-013-2240-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Burcak Bilginer
- Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey,
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Graillon T, Metellus P, Adetchessi T, Dufour H, Fuentes S. Adult symptomatic and growing arachnoid cyst successfully treated by ventriculocystostomy: a new insight on adult arachnoid cyst history. Neurochirurgie 2013; 59:218-20. [PMID: 24210287 DOI: 10.1016/j.neuchi.2013.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/04/2013] [Accepted: 09/28/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adult arachnoid cysts are known to be stable and asymptomatic but their history remains undefined. CASE DESCRIPTION The authors report the case of an 81-year-old woman with progressive hemiplegia and aphasia. CT scan revealed a voluminous left frontotemporal arachnoid cyst with a major mass effect on the midline and contralateral blocked hydrocephalus. Endoscopic ventriculocystostomy was performed with a spectacular neurological improvement. DISCUSSION AND CONCLUSIONS Symptomatic adult arachnoid cysts are extremely rare. To our knowledge, no similar clinical case of a growing arachnoid cyst in elderly patients has yet been reported in the literature. The mechanisms of cyst enlargement and decompensation still remain undefined and debated. The possibility of adult arachnoid cyst growth has to be considered in clinical practice. Endoscopic ventriculocystostomy is as effective as in paediatric cases.
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Affiliation(s)
- T Graillon
- Aix-Marseille université, 13284 Marseille, France; Service de neurochirurgie, hôpital la Timone Adulte, AP-HM, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Fiorindi A, Delitala A, Francaviglia N, Longatti P. Neuroendoscopic options in the treatment of mesencephalic expanding cysts: Report of four cases and review of the literature. Clin Neurol Neurosurg 2013; 115:2370-6. [DOI: 10.1016/j.clineuro.2013.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/18/2013] [Accepted: 08/25/2013] [Indexed: 11/30/2022]
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Gronier S, Ayrignac X, Lamy C, Honnorat J, Thomas P, Lebrun-Frenay C, Labauge P. [Symptomatic giant Virchow-Robin spaces]. Rev Neurol (Paris) 2013; 169:898-902. [PMID: 24119855 DOI: 10.1016/j.neurol.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/25/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Perivascular spaces, known as Virchow-Robin spaces (VRS), may become massively enlarged but are usually an incidental finding. However, a few reports on patients with unusually large VRS have mentioned association with neurological symptoms. We report a series of three symptomatic patients with extremely wide Virchow-Robin spaces documented on brain magnetic resonance imaging (MRI). METHODS We retrospectively analyzed the medical records and brain MRI of three symptomatic patients, who had been diagnosed with VRS widening. CASE REPORTS In all three patients, the unusual widening of the VRS was located within the subcortical white matter with asymmetric distribution. Their neurological symptoms were epilepsy and neurological deficits which correlated well with the lesions seen on the MRI. Two patients had associated white matter hyperintensities: in the first case associated gliosis and in the second case, with vascular leukoencephalopathy. CONCLUSIONS Enlarged symptomatic VRS are rare. The underlying pathophysiological mechanisms remain uncertain. We report three cases with symptomatic giant dilatation of the Virchow-Robin spaces.
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Affiliation(s)
- S Gronier
- Service de neurologie, pôle de neurosciences cliniques, CHU de Nice, hôpital Pasteur, 30, voie Romaine, 06002 Nice cedex 1, France
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Ranjan M, Dupre S, Honey CR. Trigeminal neuralgia secondary to giant Virchow-Robin spaces: a case report with neuroimaging. Pain 2013; 154:617-619. [PMID: 23452387 DOI: 10.1016/j.pain.2013.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/20/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022]
Abstract
Virchow-Robin spaces are pial-lined, interstitial, fluid-filled structures that accompany penetrating arteries and arterioles as they enter the cerebral substance. Occasionally they may enlarge and become giant Virchow-Robin spaces (GVRS) and produce mass effect. Various neurological symptoms have been described in association with GVRS, however, trigeminal neuralgia has not yet been reported in this context. We present a case of trigeminal neuralgia secondary to dorsal pontine giant Virchow-Robin spaces (GVRS) and highlight the diagnostic radiologic features. Routine 1.5 T MRI sequences were sufficient to diagnose the GVRS and a diffusion tensor imaging (DTI) study revealed distortion of the intrinsic trigeminal pathway. This study highlights the utility of routine MRI to study the intrinsic anatomy of the trigeminal pathway in pathological conditions.
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Affiliation(s)
- Manish Ranjan
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada Division of Neuroradiology, University of British Columbia, Vancouver, British Columbia, Canada
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Fujimoto K, Kuroda JI, Hide T, Hasegawa Y, Yano S, Kuratsu JI. Giant tumefactive perivascular spaces that expanded and became symptomatic 14 years after initial surgery. Surg Neurol Int 2012; 3:127. [PMID: 23227432 PMCID: PMC3513852 DOI: 10.4103/2152-7806.102942] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/19/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Perivascular spaces (PVSs) or Virchow-Robin spaces in the brain are pial-lined interstitial fluid (ISF)-filled structures surrounding the penetrating arteries and arterioles. These spaces appear as 1- to 2-mm in diameter, round, oval, or curvilinear smooth-walled structures on magnetic resonance imaging (MRI). Typical PVSs are asymptomatic. Occasionally, they become enlarged and cause specific clinical manifestations that depend on location and the degree of tissue compression. In this case, they are referred to as giant tumefactive PVSs. To our knowledge, there have been no reported cases in which giant PVSs increased remarkably in number and size during both the natural course and postoperative course. We describe a rare progression of giant tumefactive PVSs 14 years after initial surgery. CASE DESCRIPTION On first admission at age 17, endoscopic ventriculocystostomy and third ventriculostomy were performed to relieve hydrocephalus caused by cysts compressing the cerebral aqueduct. Fourteen years later, the multicystic lesion reappeared with an increase in both cyst number and size. The patient showed no hydrocephalus but presented with oculomotor and trochlear nerve palsies, which were caused by a mass effect on the midbrain. Endoscopic ventriculocystostomy was performed and symptoms improved. CONCLUSION This is the first case report in which giant PVSs increased significantly in number and size.
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Affiliation(s)
- Kenji Fujimoto
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
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Bayram E, Akinci G, Topcu Y, Cakmakci H, Giray O, Ercal D, Hiz S. Multi-cystic white matter enlarged Virchow Robin spaces in a 5-year-old boy. Childs Nerv Syst 2012; 28:743-6. [PMID: 22205532 DOI: 10.1007/s00381-011-1663-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Erhan Bayram
- Division of Pediatric Neurology, Department of Pediatrics, Dokuz Eylul University, Izmir, Turkey.
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Tortora F, Cirillo M, Belfiore M, Pepe D, Pezzullo F, Barbarisi M, Cirillo S. Spontaneous Regression of Dilated Virchow-Robin Spaces. Neuroradiol J 2012; 25:40-4. [DOI: 10.1177/197140091202500106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/14/2012] [Indexed: 11/16/2022] Open
Abstract
We describe a 28-year-old woman with a dilated perivascular spaces in the right prerolandic district. The purpose of this article is to provide an in-depth overview of the MR imaging features of VR spaces and to describe magnetic resonance imaging evidence of complete regression of dilated perivascular spaces 2.
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Affiliation(s)
- F. Tortora
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
| | - M. Cirillo
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
| | - M.P. Belfiore
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
| | - D. Pepe
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
| | - F. Pezzullo
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
| | - M. Barbarisi
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
| | - S. Cirillo
- Neuroradiology Unit, Department of Neurological Sciences, Seconda University of Naples; Naples, Italy
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Yuan Y, Liu SY, Tao XF. Unilateral bubbly cystic brain lesions on MRI. J Clin Neurosci 2012. [DOI: 10.1016/j.jocn.2010.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tsutsumi S, Ito M, Yasumoto Y, Tabuchi T, Ogino I. The Virchow-Robin spaces: delineation by magnetic resonance imaging with considerations on anatomofunctional implications. Childs Nerv Syst 2011; 27:2057-66. [PMID: 21909964 DOI: 10.1007/s00381-011-1574-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/31/2011] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The Virchow-Robin spaces (V-R spaces) are well-known, but not systematically understood fluid-filled perivascular spaces that allow the convexity and basal perforating vessels to penetrate deep into the cerebral parenchyma. OBJECTIVE This study aims to delineate anatomical characteristics of the normal V-R spaces by MR imaging with considerations on clinical and anatomofunctional implications of the V-R spaces. METHODS In this prospective study with 3T magnetic resonance (MR) imaging, the whole extent of the intracranial V-R spaces was classified into basal, cortical, subcortical, paraventricular, and brainstem segments, on the basis of the topological difference in 105 control subjects. Morphological characteristics in each segment of the V-R spaces are described. For comparison with the neuroimaging appearance, V-R spaces were histologically examined in cadaveric human brains. The physiological functions of the V-R spaces and pathognomonic implications of unusually dilated, but asymptomatic, V-R spaces encountered in five subjects are discussed. RESULTS The V-R spaces were found to form a complicated, while anatomically highly consistent, intraparenchymal canal network distributed over the whole cerebral hemispheres and connect the cerebral convexity, basal cistern, and ventricular system. CONCLUSION The V-R spaces may be essential for drainage routes of cerebral metabolites, additional buoyancy for the brain, and maintenance of homogenous intracranial pressure. MR imaging may be more advantageous in depicting the V-R spaces than histological examination.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan.
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Cherif El Asri A, Akhaddar A, Naama O, Boulahroud O, Belhachmi A, Belfquih H, Gazzaz M, El Mostarchid B, Boucetta M. [Neuroepithelial thalamo-mesencephalic cyst]. Neurochirurgie 2011; 58:44-6. [PMID: 22030167 DOI: 10.1016/j.neuchi.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 09/13/2011] [Indexed: 11/30/2022]
Abstract
Thalamo-mesencephalic neuroepithelial cysts are rare lesions of the central nervous system. They are thought to arise from neuroectoderm and are also referred to as ependymal cysts due to their origin. It can remain asymptomatic throughout life or rarely can cause symptoms. We describe a 42-year-old woman who presented with thalamic syndrome due to a neuroepithelial cyst of the thalamo-midbrain. Differential diagnosis is made with other cystic lesions in the brain. However a good analysis of imaging feature led to diagnosis. When the lesion is symptomatic, mini-invasive procedure is indicated.
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Buerge C, Steiger G, Kneifel S, Wetzel S, Wollmer MA, Probst A, Baumann TP. Lobar Dementia due to Extreme Widening of Virchow-Robin Spaces in One Hemisphere. Case Rep Neurol 2011; 3:136-40. [PMID: 21734888 PMCID: PMC3128129 DOI: 10.1159/000329267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Widened perivascular spaces known as Virchow-Robin spaces (VRS) are often seen on MRI and are usually incidental findings. It is unclear if enlarged VRS can be associated with neurological deficits. In this report, we describe a case of lobar dementia associated with unusual VRS widening in one cerebral hemisphere. A 77-year-old woman, seen at a memory clinic, presented with progressive cognitive decline, left hemianopsia, and mild pyramidal signs on the left side. On MRI, unusually wide VRS were visible, predominantly in the right centrum semiovale and the right temporo-occipital white matter. The clinical syndrome was consistent with the extent and location of the abnormally dilated VRS. The high MR signal in white matter bridges between the VRS suggested parenchymal damage, possibly representing gliotic white matter. No evidence for another etiology was found on cerebral MRI and rCBF SPECT. As a conclusion, enlarged VRS in one cerebral hemisphere may be associated with cognitive change and neurological deficits.
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Affiliation(s)
- Christine Buerge
- Memory Clinic, Department of Geriatrics, University Hospital Basel, Basel, Switzerland
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Sturiale CL, Albanese A, Lofrese G, Frassanito P, Sabatino G, Marchese E, Puca A. Pathological enlargement of midbrain Virchow-Robin spaces: a rare cause of obstructive hydrocephalus. Br J Neurosurg 2010; 25:130-1. [PMID: 20825291 DOI: 10.3109/02688697.2010.504050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Midbrain multiloculated cystic formations can rarely origin by enlargement of Virchow-Robin spaces surrounding mesencephalo-thalamic artery and branches of the collicular and accessory collicular arteries. They can determine several pictures of midbrain syndrome and obstructive hydrocephalus. The authors describe a 38 year-old man affected by a Benedikt's syndrome related to a midbrain multicystic formation. Clinical course, differential diagnosis, and therapeutic choice are here also briefly discussed.
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Mesencephalic enlarged Virchow-Robin spaces in a 6-year-old boy: a case-based update. Childs Nerv Syst 2010; 26:1155-60. [PMID: 20437240 DOI: 10.1007/s00381-010-1164-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 04/22/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Perivascular spaces or Virchow-Robin spaces are normal anatomical structures within the brain, typically less than 5 mm in diameter. Rarely, they can reach much larger sizes and adopt bizarre single or multi-cystic configurations, as was the case in the patient that we report on. When there is such markedly gross dilatation, the phenomenon is known as Giant or tumefactive perivascular space enlargement. CASE REPORT We report a 6-year-old boy with a multi-cystic mesencephalic lesions presenting with obstructive hydrocephalus secondary to obstruction of the aqueduct of Sylvius due to tumefactive dilatation of Virchow-Robin spaces. The patient underwent an endoscopic fenestration and biopsy of the cystic portion abutting into the ventricular system. CONCLUSION In this paper, we discuss the phenomenon of perivascular (Virchow-Robin) spaces and their treatment options and review the relevant literature. To our knowledge, this is the first pediatric case of tumefactive dilatation of the Virchow-Robin spaces causing obstructive hydrocephalus that were directly fenestrated using neuroendoscopy.
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Klinische Bedeutung normaler und erweiterter Virchow-Robin-Räume. DER NERVENARZT 2010; 81:727-33. [DOI: 10.1007/s00115-010-2983-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Cerase A, Vallone IM, Muccio CF, Petrini C, Signori G, Venturi C. Regression of dilated perivascular spaces of the brain. Surg Radiol Anat 2009; 32:555-61. [PMID: 19957183 DOI: 10.1007/s00276-009-0603-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 11/20/2009] [Indexed: 02/01/2023]
Abstract
PURPOSE Perivascular, or Virchow-Robin, spaces of the brain represent interstitial fluid-filled spaces continuous with subpial spaces, and not invagination of cerebrospinal fluid-filled subarachnoid spaces. Regression of a dilated, or even giant, perivascular space occurs rarely. The purpose of this paper is to describe magnetic resonance imaging evidence of complete regression of dilated perivascular spaces (dPVSs). METHODS Patient 1 was a 76-year-old woman with right hemiparesis and aphasia from a left cranial vault meningioma infiltrating the superior sagittal sinus, and a left temporal lobe giant perivascular space. Patient 2 was a 70-year-old man with pituitary apoplexy, vasospasm, cerebral ischemia, and two dPVSs, one in the right temporal lobe, and one in the left anterior perforate substance. Patient 3 was a 78-year-old man with a generalized seizure, and a right temporal lobe dPVS. RESULTS In all the patients, temporal lobe giant or dPVSs underwent regression, following meningioma subtotal resection (patient 1) or pituitary lesion shrinkage (patient 2), or spontaneously (patient 3). In patient 2, the left anterior perforate substance dPVS was unchanged. CONCLUSIONS Temporal lobe giant or dPVSs may regress, eventually together with resection or regression of intracranial tumors, also distant from the PVSs. Cerebral edema does not seem the only factor influencing dilatation of PVSs.
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Affiliation(s)
- Alfonso Cerase
- Unità Operativa Complessa di Neuroimmagini e Neurointerventistica, Dipartimento di Neuroscienze, Policlinico "Santa Maria alle Scotte", Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy.
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Abstract
Perivascular space (PVS) is a crevice between two slices of cerebral pia maters, filled with tissue fluid, which be formed by pia mater emboling in the surrounding of cerebral perforating branch (excluding micrangium). Normal PVS (diameter < 2 mm) can be found in almost all healthy adults; however enlarged PVS (diameter > 2 mm) has correlation with neurological disorders probably. The article reviews the formation mechanism, imageology characteristics and the relation with neurological disorders of PVS, which is beneficial to the research of some neurological disorders etiopathogenesis and treatment.
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Lefranc M, Peltier J, Bugnicourt JM, Lamy C, Deramond H, Toussaint P, Le Gars D. [Giant cystic widening of Virchow-Robin spaces, case report]. Morphologie 2008; 92:82-6. [PMID: 18809350 DOI: 10.1016/j.morpho.2008.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Virchow-Robin spaces are very well-known anatomical and radiological entities. However, the observation of giant cystic widening of Virchow-Robin spaces is anecdotic. We report herein the case of a patient presenting with giant cystic widening of Virchow-Robin spaces located in both cerebral hemispheres. OBSERVATION A 26-year-old female presented with numbness of left arm and then, of both arms. CT scan showed many hypodensities located in the two hemispheres. Neurologic examination was normal. MR imaging allowed the diagnosis of giant cystic widening Virchow-Robin spaces in T2, T2*, T1 gadolinium and Flair weighted images. Neuropsychological investigations were normal. CONCLUSION Giant cystic widening of Virchow-Robin spaces are extremely rare entities. MR imaging helps the diagnosis. Only extreme dilatation of Virchow-Robin perivascular spaces close to ventricular system must be watched and treated in case of an obstructive hydrocephalus risk. When located in cerebral hemispheres, these dilatations are mostly asymptomatic and must not be confused with a cystic tumoral disease.
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Affiliation(s)
- M Lefranc
- Service de neurochirurgie, CHU d'Amiens, 5, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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Endo H, Fujimura M, Watanabe M, Tominaga T. Neuro-endoscopic management of mesencephalic intraparenchymal cyst: a case report. ACTA ACUST UNITED AC 2008; 71:107-10; discussion 110. [PMID: 18291476 DOI: 10.1016/j.surneu.2007.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intraparenchymal cyst of the mesencephalon is rare, and its natural course is unclear. The optimal treatment for this entity is still undetermined. CASE DESCRIPTION A 54-year-old woman was found to have asymptomatic multilobulated mesencephalic cysts. Two years after the initial diagnosis, she experienced headache and double vision, when MRI showed the enlargement of the multilobulated cystic lesions which markedly compressed the mesencephalon and the aqueduct, resulting in noncommunicating hydrocephalus. She underwent diagnostic endoscopic biopsy and ETV by flexible endoscopic system, which revealed the mesensephalic cyst wall at the dorsal part of the third ventricle floor. A part of the cyst membrane was carefully excised by endoscopic forceps without injuring the surrounding structures. Histopathological examination revealed that the cyst wall was exclusively neuroglial tissue, and the presence of neoplasm was ruled out. Her symptoms were relieved immediately after surgery, and postoperative MRI showed both the shrinkage of mesencephalic cysts and the improvement of hydrocephalus. There is no recurrence of her symptoms, and MRI findings have been stable during the 3 year follow-up period. CONCLUSION Intraparenchymal cysts of the mesencephalon have an expanding nature. Once those cysts become symptomatic, we recommend endoscopic procedure including decompression and biopsy of the cyst with ETV.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
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Mathias J, Koessler L, Brissart H, Foscolo S, Schmitt E, Bracard S, Braun M, Kremer S. Giant cystic widening of Virchow-Robin spaces: an anatomofunctional study. AJNR Am J Neuroradiol 2007; 28:1523-5. [PMID: 17846204 PMCID: PMC8134401 DOI: 10.3174/ajnr.a0622] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe 2 patients with unusual white matter cystic dilations, which could correspond to widening of the perivascular spaces. They underwent morphologic MR imaging with tractography, functional MR imaging (fMRI), and neuropsychological evaluation. fMRI examination showed no functional reorganization of cortical areas. Tractography showed an apparent decrease of white matter tract vectors into the regions of concern. Findings of the neuropsychological examination were normal. It seems that even an extensive cystic dilation of white matter does not deteriorate brain function.
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Affiliation(s)
- J Mathias
- Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier et Universitaire de Nancy, France
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Abstract
Virchow-Robin (VR) spaces surround the walls of vessels as they course from the subarachnoid space through the brain parenchyma. Small VR spaces appear in all age groups. With advancing age, VR spaces are found with increasing frequency and larger apparent sizes. At visual analysis, the signal intensity of VR spaces is identical to that of cerebrospinal fluid with all magnetic resonance imaging sequences. Dilated VR spaces typically occur in three characteristic locations: Type I VR spaces appear along the lenticulostriate arteries entering the basal ganglia through the anterior perforated substance. Type II VR spaces are found along the paths of the perforating medullary arteries as they enter the cortical gray matter over the high convexities and extend into the white matter. Type III VR spaces appear in the midbrain. Occasionally, VR spaces have an atypical appearance. They may become very large, predominantly involve one hemisphere, assume bizarre configurations, and even cause mass effect. Knowledge of the signal intensity characteristics and locations of VR spaces helps differentiate them from various pathologic conditions, including lacunar infarctions, cystic periventricular leukomalacia, multiple sclerosis, cryptococcosis, mucopolysaccharidoses, cystic neoplasms, neurocysticercosis, arachnoid cysts, and neuroepithelial cysts.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Ahmad FU, Garg A, Singh M, Mishra NK. Giant mesencephalothalamic virchow-robin spaces causing obstructive hydrocephalus. A case report. Neuroradiol J 2007; 20:303-6. [PMID: 24299672 DOI: 10.1177/197140090702000310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 04/22/2007] [Indexed: 11/16/2022] Open
Abstract
Virchow-Robin spaces accompany arteries for a variable distance into the brain substance. They are usually small but can be identified on high resolution MRI images in patients of all age groups. We report a rare case of a 40-year-old woman with giant mesencephalothalamic Virchow-Robin spaces which caused hydrocephalus requiring CSF diversion. After right ventriculoperitoneal shunt the patient recovered completely.
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Affiliation(s)
- F U Ahmad
- All India Institute of Medical Sciences; New Delhi, India -
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Kim DG, Oh SH, Kim OJ. A case of disseminated polycystic dilated perivascular spaces presenting with dementia and parkinsonism. J Clin Neurol 2007; 3:96-100. [PMID: 19513299 PMCID: PMC2686866 DOI: 10.3988/jcn.2007.3.2.96] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 05/25/2007] [Indexed: 11/17/2022] Open
Abstract
The perivascular spaces (PVSs) of the brain are lined with pia and contain interstitial fluid. In general, PVSs are small, asymptomatic, and identifiable at all ages. When PVSs are significantly enlarged, they can produce various clinical manifestations such as headache and dizziness. A 67-year-old man was admitted with cognitive impairment and gait disturbance with a 5-month history. Brain MRI showed multiple cystic PVSs in periventricular and subcortical white matter of both hemispheres. Medication with dopaminergic agents produced a moderate clinical improvement, while anticholinesterase was not effective. This case suggests that disseminated polycystic dilated PVSs may present with dementia and Parkinsonism.
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Affiliation(s)
- Dong-Gun Kim
- Department of Neurology, Pochon CHA University, College of Medicine, Sungnam, Korea
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Abstract
The meninges comprise the dura mater and the leptomeninges (arachnoid and pia mater). Dura forms an outer endosteal layer related to the bones of the skull and spine and an inner layer closely applied to the arachnoid mater. Leptomeninges have multiple functions and anatomical relationships. The outer parietal layer of arachnoid is impermeable to CSF due to tight intercellular junctions; elsewhere leptomeningeal cells form demosomes and gap junctions. Trabeculae of leptomeninges compartmentalize the subarachnoid space and join the pia to arachnoid mater. In bacterial meningitis leptomeningeal cells secrete cytokines. Pia mater is reflected from the surface of the brain and spinal cord onto arteries and veins, thus separating the subarachnoid space from the brain and cord. A sheath of leptomeninges accompanies arteries into the brain and is related to the pathways for the drainage of interstitial fluid that play a role in inflammatory responses in the brain and appear to be blocked by amyloid-beta in Alzheimer's disease. Specialised leptomeningeal cells in the stroma of the choroid plexus form collagen whorls that become calcified with age. Leptomeningeal cells also form channels in the core and apical cap of arachnoid granulations for the drainage of CSF into venous sinuses. In the spine, leptomeninges form highly perforated intermediate sheets of arachnoid and delicate ligaments that compartmentalize the subarachnoid space; dentate ligaments anchor subpial collagen to the dura mater and stabilize the spinal cord. Despite the multiple anatomical arrangements and physiological functions, leptomeningeal cells retain many histological features that are similar from site to site.
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Affiliation(s)
- R O Weller
- Clinical Neurosciences, Southampton University School of Medicine, Mail Point 813, Southampton General Hospital, Southampton SO16 6YD, UK.
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