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Images in Neurology |

Giant Virchow-Robin Spaces: Functional Magnetic Resonance Imaging and Tractography

Sui Hsien Wong, MRCP; Kumar Das, FRCR; Mani Puthuran, FRCR; Bryan Lecky, MD; Richard White, MD
Arch Neurol. 2010;67(6):768-769. doi:10.1001/archneurol.2010.92.
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A 59-year-old, right-handed man presented with orbital apex syndrome, which resolved with corticosteroids. He was otherwise completely healthy. Incidentally, he had strikingly abnormal magnetic resonance imaging (MRI) results owing to giant widening of the Virchow-Robin spaces (Figure 1). To determine whether the abnormal-looking hemisphere was functioning normally, we performed magnetic resonance tractography and functional MRI (fMRI) studies with a high-field MRI scanner (Philips Achieva 3T; Koninklijke Philips Electronics NV, Eindhoven, the Netherlands). Magnetic resonance tractography by diffusion tensor imaging acquisition (32 directions; repetition time, 3995 milliseconds; echo time, 72 milliseconds; matrix, 128 × 128) with fiber tracking (FiberTrak Software; Philips Medical System Inc, Newnan, Georgia) showed that volume and density of fiber tracts in the left hemisphere were slightly reduced compared with those in the right hemisphere (Figure 1).

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Figure 1.

Brain magnetic resonance images. Axial T2 (A), fluid-attenuated inversion recovery (B), and sagittal T1 (C) sequences show extreme unilateral widening of Virchow-Robin (perivascular) spaces. The signal intensity within the cystic spaces is the same as that of cerebrospinal fluid in all sequences, suggesting that the spaces are filled with cerebrospinal fluid. Magnetic resonance tractography (D) demonstrates an apparent reduction of fiber tracts in the left hemisphere compared with the right. However, cerebral peduncles appear symmetrical (highlighted in the yellow box).

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Figure 2.

Functional magnetic resonance imaging: language and motor skills. A, Functional magnetic resonance imaging of language skills showing left hemispheric activation. B, Functional magnetic resonance imaging of motor skills comparing finger tapping in right and left hands. The top row demonstrates functional magnetic resonance imaging with left-hand finger tapping (contralateral hemispheric activation); the bottom row shows functional magnetic resonance imaging with right-hand finger tapping (bilateral hemispheric activation: activation within the left primary motor cortex Brodmann area 4, supplementary motor and superior-parietal area, and the right primary motor and premotor region).

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