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A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis

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...

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Autores principales: Woo, Peter Yat-Ming, Cheung, Eric, Zhuang, James Ting-Fong, Wong, Hoi-Tung, Chan, Kwong-Yau
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208240/
https://www.ncbi.nlm.nih.gov/pubmed/30459922
http://dx.doi.org/10.4103/ajns.AJNS_108_18
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author Woo, Peter Yat-Ming
Cheung, Eric
Zhuang, James Ting-Fong
Wong, Hoi-Tung
Chan, Kwong-Yau
author_facet Woo, Peter Yat-Ming
Cheung, Eric
Zhuang, James Ting-Fong
Wong, Hoi-Tung
Chan, Kwong-Yau
author_sort Woo, Peter Yat-Ming
collection PubMed
description 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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spelling pubmed-62082402018-11-20 A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis Woo, Peter Yat-Ming Cheung, Eric Zhuang, James Ting-Fong Wong, Hoi-Tung Chan, Kwong-Yau Asian J Neurosurg Case Report 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. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6208240/ /pubmed/30459922 http://dx.doi.org/10.4103/ajns.AJNS_108_18 Text en Copyright: © 2018 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Woo, Peter Yat-Ming
Cheung, Eric
Zhuang, James Ting-Fong
Wong, Hoi-Tung
Chan, Kwong-Yau
A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis
title A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis
title_full A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis
title_fullStr A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis
title_full_unstemmed A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis
title_short A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis
title_sort giant tumefactive perivascular space: a rare cause of obstructive hydrocephalus and monoparesis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208240/
https://www.ncbi.nlm.nih.gov/pubmed/30459922
http://dx.doi.org/10.4103/ajns.AJNS_108_18
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