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A Rare Case of Expanding Virchow Robin Spaces Mimicking Cystic Tumor and Causing Hydrocephalus

RESUMO

Case presentation: A 57 year women presented with progressive imbalance and right hemiparesis progressing in three months. Chikungunya infection 3 years before was reported. Magnetic resonance imaging (MRI) showed cystic lesions in the midbrain and obstructive hydrocephalus. The features suggested abnormal dilatation of perivascular spaces. The lesion was partially resected, with good evolution of symptoms with three-year postoperative follow-up. Discussion: Perivascular enlargements, or Virchow-Robin spaces (VRS), are seen on MR images as small foci that are isointense to the CSF, like small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Small Virchow-Robin spaces appear in all age groups. Age, arterial hypertension, dementia, and the incidental white matter, lesions were found to be significantly associated with large Virchow-Robin spaces In a retrospective study of MR imaging. Typically, they have no mass effect and are asymptomatic, but in our patient and in other studies showed that the perivascular spaces can expande more than usual, acting as space-occupying lesions. Poirier et al reported the first case of expanding lacunae in a 54-year-old woman with dementia. Surgical treatment for the hydrocephalus has produced different results; Ono et al reported a case wherein cystectomy combined with a third ventricle-to-peritoneum shunt improved the symptoms and decreased the size of both ventricles and cysts. Final comments: Virchow-Robin spaces are typically considered incidental but can be symptomatic in rare cases. The typical scan characteristic and location of Virchow Robin spaces can help to differentiate from cystic mass lesions. However, despite advanced MRI techniques, sometimes it is still difficult to differentiate VRS from some cystic brain tumors.