Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Mini Review Volume 4 Issue 6

Tumefactive Virchow Robin Spaces and its Mimics in Paediatric Patients: A Pictorial Review

Bhavini Gupta1*, Sumit Pruthi2, Omprakash Tavri1 and Sarfaraz Shaikh1

1Department of Radiology, Dr. D.Y. Patil University School of Medicine, India
2Vanderbilt Children’s Hospital, Nashville, Tennessee, USA

*Corresponding Author: Bhavini Gupta, Department of Radiology, Dr. D.Y. Patil University School of Medicine, India.

Received: April 14, 2021; Published: May 20, 2021

Abstract

  Virchow Robin spaces represent pial-lined perivascular spaces and correspond to extensions of subarachnoid space, found in certain characteristic locations around the brain. These spaces are predominantly filled with interstitial fluid and follow CSF intensity on imaging. Enlarged Virchow-Robin spaces, also known as enlarged perivascular spaces (EPVS) are considered when their size increases beyond 2 mm.

  EPVS can have varied appearance and may appear in varying locations, making diagnosis difficult. They may be found in normal young individuals, in the mesencephalon, hippocampus and basal ganglia regions, but are usually associated with lower cognition in the healthy older population. Among the younger patients, EPVS are associated with inflammatory and metabolic disorders. While EPVS is common, it is generally overlooked due to their uncertain pathophysiology.

  The current review aims to evaluate and characterize different pathologies associated with enlarged and prominent Virchow-Robin spaces and demonstrate the uncommon presentations of common entities that mimic prominent VR spaces. Due to the lack of clinical data, a large proportion of the cases presented in this study are misdiagnosed as some of their commoner counterparts, limning the need to outline characteristic features of these diseases. This will help to tailor treatment appropriately and help the patients who suffer from these disorders.

  Presenting cases of enlarged bilateral tumefactive VR spaces were studied retrospectively, including their biochemical, genetic, and clinical features, to finally arrive at a diagnosis.

Keywords: Tumefactive VR Spaces; Virchow-Robin Spaces; Neuroradiology; Periventricular Cysts

References

  1. Ozturk MH and Aydingoz U. “Comparison of MR signal intensities of cerebral perivascular (Virchow-Robin) and subarachnoid spaces”. Journal of Computer Assisted Tomography 26 (2002): 902-904.
  2. Song CJ., et al. “MR imaging and histologic features of subinsular bright spots on T2-weighted MR images: Virchow-Robin spaces of the extreme capsule and insular cortex”. Radiology 214 (2000): 671-677.
  3. Pollock H., et al. “Perivascular spaces in the basal ganglia of the human brain: their relationship to lacunes”. Journal of Anatomy 191 (1997): 337-346.
  4. Heier LA., et al. “Large Virchow-Robin spaces: MR-clinical correlation”. American Journal of Neuroradiology 10 (1989): 929-936.
  5. Karen L Salzman., et al. American Journal of Neuroradiology2 (2005): 298-305.
  6. Hutchings M and Weller RO. “Anatomical relationships of the pia mater to cerebral blood vessels in man”. Journal of Neurosurgery 65 (1986): 316-325.
  7. Zhang ET., et al. “Interrelationship of the pia mater and the perivascular (Virchow-Robin) spaces in the human cerebrum”. Journal of Anatomy 170 (1990): 111-123.
  8. Schley D., et al. “Mechanisms to explain the reverse perivascular transport of solutes out of the brain”. Journal of Theoretical Biology 238 (2006): 962-974.
  9. Homeyer P., et al. “A special form of cerebral lacunae: expanding lacunae”. Journal of Neurology, Neurosurgery, and Psychiatry 61 (1996): 200-202.
  10. Mascalchi M., et al. “Expanding lacunae causing triventricular hydrocephalus: report of two cases”. Journal of Neurosurgery 91 (1999): 669-674.
  11. Poirier J., et al. “Thalamic dementia: expansive lacunae of the thalamo-paramedian mesencephalic area—hydrocephalus caused by stenosis of the aqueduct of Sylvius [in French]”. Review on Neurology (Paris) 139 (1983): 349-358.
  12. Benhaiem-Sigaux N., et al. “Expanding cerebellar lacunes due to dilatation of the perivascular space associated with Binswanger’s subcortical arteriosclerotic encephalopathy”. Stroke 18 (1987): 1087-1092.
  13. Hughes W. “Origin of lacunes”. Lancet 2 (1965): 19-21.
  14. Awad IA., et al. “Incidental subcortical lesions identified on magnetic resonance imaging in the elderly”. II. Postmortem pathological correlations”. Stroke 17 (1986): 1090-1097.
  15. Braffman BH., et al. “Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin spaces”. AJR American Journal of Roentgenology 151 (1988): 551-558.
  16. Demaerel P., et al. “Widening of Virchow-Robin spaces”. AJNR American Journal of Neuroradiology 17 (1996): 800-801.
  17. Ruggieri M and Pavone L. “Hypomelanosis of Ito: clinical syndrome or just phenotype?” Journal of Child Neurology 15 (2000): 635-644.
  18. Ruiz-Maldonado R., et al. “Hypomelanosis of Ito: diagnostic criteria and report of 41 cases”. Pediatric Dermatology 9 (1992): 1-10.
  19. Groeschel S., et al. “Virchow-Robin spaces on magnetic resonance images: Normative data, their dilatation, and a review of the literature”. Neuroradiology 48 (2006): 745-54.
  20. Mohan S., et al. “Virchow-Robin spaces in health and disease”. Neuroradiology 22 (2009): 518-524.
  21. Kwee RM and Kwee TC. “Virchow-Robin spaces at MR imaging”. Radiographics 27 (2007): 1071-1086.
  22. Coward RJ., et al. “Kidney disease in hypomelanosis of Ito”. Nephrology Dialysis Transplantation 16 (2001): 1267-1269.
  23. Adriana S de Almeida., et al. “Hypomelanosis of Ito, neurocutaneous syndromes, incontinentia pigmenti achromians”. Journal of Pediatrics (Rio J) 77.1 (2001): 59-62.
  24. Phadke RV., et al. Multicystic encephalomalacia secondary to head trauma”. Journal of Neurosciences in Rural Practice 1 (2017): 158-159.
  25. https://www.eurorad.org/case/1095
  26. Garten L., et al. “Progressive multicystic encephalopathy: Is there more than hypoxia-ischemia?” Journal of Child Neurology 22 (2007): 645-649.
  27. Alam A and Sahu S. “Magnetic Resonance Imaging in Evaluation of Periventricular Leukomalacia”. Medical Journal Armed Forces India 4 (2010): 374-380.
  28. Schouman-Claeys E., et al. “Periventricular leukomalcia: correlation between MR imaging and autopsy findings during the first two months of life”. Radiology 189 (1993): 59-64.
  29. Hill A., et al. “Haemorrhagic periventricular leukomalacia: diagnosis by real time ultrasound and correlation with autopsy findings”. Paediatrics 69 (1982): 282-284.
  30. Siea Lilian T., et al. “Early MR Features of Hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms”. American Journal of Nemoradiology 21 (2000): 852-861.
  31. Prayson RA. “Neuropathology: A Volume in the Series: Foundations in Diagnostic Pathology (Expert Consult - Online and Print)”. 2e. Saunders.
  32. Elster Ad and Richardson DN. “Focal high signal on MR scans of the midbrain caused by enlarged perivascular spaces: MR-pathologic correlation”. AJNR American Journal of Neuroradiology 11 (1991): 1119-112.
  33. Heier LA., et al. “Large Virchow-Robin spaces: MR-clinical correlation”. AJNR American Journal of Neuroradiology 10 (1998): 929-936.
  34. Jungreis CA., et al. “Normal perivascular spaces mimicking lacunar infarction: MR imaging”. Radiology 169 (1988): 101-104.
  35. Sasaki M., et al. “Hippocampal sulcus remnant: potential cause of change in signal intensity in the hippocampus”. Radiology 188 (1993): 743-746.
  36. Duvernoy HM. “Human Brainstem Vessels”. Berlin: Springer-Verlag (1978): 16-66.
  37. Saeki N., et al. “Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis”. Journal of Neurosurgery 46 (1977): 563-578
  38. Matlung SE., et al. “Multicystic encephalomalacia as an end-stage finding in abusive head trauma”. Forensic Science, Medicine, and Pathology4 (2011): 355.
  39. do Amaral LL., et al. “Neurocysticercosis: evaluation with advanced magnetic resonance techniques and atypical forms”. Topics in Magnetic Resonance Imaging 16 (2005): 127-144.
  40. Dumas JL., et al. “Parenchymal neurocysticercosis: follow-up and staging by MRI”. Neuroradiology 39 (1997): 12-18.
  41. Van Tassel P and Cure JK. “Nonneoplastic intracranial cysts and cystic lesions”. Seminars in Ultrasound, CT and MRI 16 (1995): 186-211.
  42. Johnson JL and Duran M. “Molybdenum cofactor deficiency and isolated sulfite oxidase deficiency”. In: Scriver CR, Deaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Basis of Inherited Disease. 8th New York, NY: McGraw-Hill (1995): 2271-2283.
  43. Rupar CA., et al. “Isolated sulfite oxidase deficiency”. Neuropediatrics 27 (1996): 299-304.
  44. Jeffrey D., et al. “Neuroimaging of Dilated Perivascular Spaces: From Benign and Pathologic Causes to Mimics”. Journal of Neuroimaging 2 (2018): 139-149.

Citation

Citation: Bhavini Gupta., et al. “Tumefactive Virchow Robin Spaces and its Mimics in Paediatric Patients: A Pictorial Review”. Acta Scientific Neurology 4.6 (2021): 85-95.

Copyright

Copyright: © 2021 Bhavini Gupta., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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