Virchow-Robin spaces cyst.

摘要: IntroductionVirchow –Robin spaces (VRS) are pial-lined, interstitial fluid-filled perivascular that surround the perforating cere-bral vessels. These normal anatomical structures thoughtto be involved in drainage of fluid and also toplay an immunomodulatory role by hosting macrophages [2,21].Theirroleinmultiplesclerosis,seniledementia,andsmallvessel disease elderly has recently been addressed invarious studies [3, 29, 30]. VRS normally less than 2 mmin diameter can visible basal ganglia and/orsupratentorial white matter on high-resolution magnetic reso-nance (MR) imaging all healthy individuals [12, 26].When become focally expanded, they causeneurological symptoms resulting from mass effect. VRSdilations occur age groups although their frequencyand size (particularly supratentorial andbasal ganglia) was found to increase with [8, 30].They appear typical locations either unilat-erally or bilaterally, solitary multiloculated, andmay cause non-specific neurological like head-ache. When located mesencephalothalamic region, theycause hydrocephalus misdiagnosed as cysticneoplasms [23]. Here, we briefly review relevant literatureon cysts focusing natural history, radiologicalimaging, differential diagnosis, management options,and report long-term follow-up a patient withmultiloculated cyst dorsal brainstem causinghydrocephalus requiring surgery.Clinical presentationVRS dilations asymptomatic unless grossly enlargeandcauseasubsequentmasseffect[23]. The prevalence ofdilatedVRSinhealthypopulationisestimatedtobeashighas1.6–4.8 % different enrolling indi-viduals who underwent brain [7, 26]. Despite highprevalence, rarely seen clinicians because mostindividuals asymptomatic.Clinical presentation depends degree expansion andspace-occupying effect cysts. Generally, symptomsreflect location. Nearly half patientssuffer headache Vertigo, cognitiveimpairments, pyramidal extrapyramidal signs, ataxia, vi-sual changes, oculomotor abnormalities, seizures werealso reportedto beassociatedwith Pediatric casesmay present developmental delay, macrocephaly,and signs [4, 23].It is worth noting whitematter, even if across large areas, do not lead severesymptoms most cases. A great portion cases asymp-tomaticandsomewerefoundtocauserelativelymildsymptomslike headache, memory disturban ces, hemifacial tics, dementia,seizures,etc.[7, 15, 16] However, inmesencephalothalamic region almost exclusively obstruc-tive due compression third ventricleand/or aquaductus cerebri. giant alsopresentwithcranialnervesignsduetomasseffect.Theliteraturesearch through Medline (via PubMed) yielded 17 inwhich total 26 patients were reported have VRScysts thus surgicalintervention [1, 4–6, 9–11, 13, 14, 17, 19, 20, 22–25, 29]. Aclinico-radiological summary these given Table 1.Radiological locationMagneticresonanceimaging(MRI)isthemodalityofchoiceforimaging VRS. Technical advances leading high-spatial-