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Giant Perivascular Spaces

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Normal variant
Created: over 4 years ago
Updated: over 4 years ago
Tags: Pets
Modality/Study Types: MR
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Child with headache

Case Images


Giant perivascular spaces


MR – Axial T2 and T2FLAIR and sagittal post gadolinium T1 images of the brain show a geographic cluster of numerous round and ovoid fluid signal lesions in the left anterior cerebrum, superior to the the Sylvian fissure.


Perivascular spaces (Virchow-Robin spaces) are pial lined interstitial spaces that accompany penetrating arteries. Blockage of interstitial drainage, increased CSF pulsations, increased arterial permeability, and abnormal deposition (amyloid, mucopolysaccharide, etc) are possible etiologies. Perivascular spaces may become quite large and amorphous. Typically, enlarged perivascular spaces occur along the lenticulostriate arteries near the anterior commissure and less commonly in the subinsular region, cerebral subcortical white matter and dentate nuclei.
Large perivascular spaces may have significant mass effect and adjacent gliosis.
Differential considerations include cystic neoplasms, parasitic cysts, cystic leukomalacia, neuroepithelial cysts, ventricular diverticula and deposition disorders.


Salzman KL, Osborn AG, House P, et al. Giant Tumefactive Perivascular Spaces. AJNR (2005);26:298-305.

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