Giant tumefactive perivascular spaces: an incidental finding

PS Idiculla, D Gurala, JH Siddiqui - Acta Neurologica Belgica, 2020 - Springer
Acta Neurologica Belgica, 2020Springer
Discussion Perivascular spaces are normal findings found on MRI and are located along
penetrating vessels. The finding is more pronounced in the elderly and patients with small
vessel disease [1]. The manifestations occur as a result of the mass effect of these enlarging
lesions. Headache (the most common complaint), vision changes, vertigo, balance
difficulties, impaired cognitive function, and seizures have been observed in affected
individuals [2]. MRI is the gold standard for diagnosis and to differentiate from more serious …
Discussion
Perivascular spaces are normal findings found on MRI and are located along penetrating vessels. The finding is more pronounced in the elderly and patients with small vessel disease [1]. The manifestations occur as a result of the mass effect of these enlarging lesions. Headache (the most common complaint), vision changes, vertigo, balance difficulties, impaired cognitive function, and seizures have been observed in affected individuals [2]. MRI is the gold standard for diagnosis and to differentiate from more serious conditions like cystic neoplasms, cryptococcosis, mucopolysaccharidosis, cystic infarction, arachnoid, and neuroepithelial cysts [3]. Characteristic findings on MRI are well-demarcated, non-enhancing, cystic lesions, displaying signal intensity identical to cerebrospinal fluid (CSF) on all sequences along perforator vessels [4]. Conservative management in the form of a “wait and watch” strategy and regular follow-up imaging is employed for asymptomatic cases, while surgical intervention is indicated for cysts that produce symptoms from obstructive hydrocephalus [2]. Endoscopic procedures are preferred over open surgery as it is relatively safer (decreased risk of hemorrhage), does not involve an exogenous shunt, and allows to obtain tissue biopsy if required [5].
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