Skip to main content Skip to main navigation menu Skip to site footer

Variety in magnetic resonance imaging of enlarged perivascular space: Case reports

  • Mohammad Ali Akbar ,
  • Muhammad Kamil ,
  • F. M. Moinuddin ,
  • Shingo Fujio ,
  • Hirofumi Hirano ,
  • Arie Ibrahim ,
  • Yuriz Bakhtiar ,
  • Thohar Arifin ,
  • Zainal Muttaqin ,
  • Kazunori Arita ,


Introduction: Expansion of perivascular spaces leads to tissue damage in the surrounding parenchyma. Enlarged perivascular spaces (EPS) have been long regarded as benign and normal variants, and have been subject to little investigation. We report three cases of EPS in unusual locations with their typical findings and clinical symptoms as consideration to differentiate them from other brain lesions.

Case presentation: The first case was a 64-year-old woman presenting with vertigo, vomiting, and shoulder stiffness.  The second case was a 25-year-old woman who worked as an agricultural trainee who complained of intermittent headaches 3 years before admission.  The third case was a 42-year-old woman with dizziness and recurring headache. The MRI finding in T1 flair was a hypointense, which was surrounded by a hyperintensity wall. T2WI revealed a hyperintensity in the superior temporal lobe, with no pathological finding to prove an ischemic or infarction process in Diffuse Weighted Imaged (DWI) and Apparent Diffusion Coefficient (ADC) images.

Conclusion: These 3 locations in our case reports should be one of consideration for diagnosing an EPS with its typical feature. A routine MRI study is needed to follow up progressivity of EPS.

Keywords: enlarged perivascular space, magnetic resonance imaging, Virchow-Robin space


  1. Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW. Brain MR: Pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin Spaces. AJR Am J Roentgenol. 1988; 151(3): 551 – 8.
  2. Adachi M, Hosoya T, Haku T, Yamaguchi K. Dilated Virchow-Robin spaces: MRI pathological study. Neuroradiology. 1998; 40(1): 27 – 31.
  3. Custer BS, Koepsell TD, Mueller BA. The association between breast carcinoma and meningioma in women. Cancer. 2002; 94(6): 1626 – 35.
  4. Rohlfs J, Riegel T, Khalil M, Iwinska-Zelder J, Mennel H-D, Bertalanffy H, Hellwig D. Enlarged perivascular spaces mimicking multicystic brain tumors. Report of two cases and review of the literature. J Neurosurg. 2005; 102(6): 1142 – 6.
  5. Doubal FN, MacLullich AM, Ferguson KJ, Dennis MS, Wardlaw JM. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke. 2010; 41(3): 450 – 4.
  6. Salzman KL, Osborn AG, House P, Jinkins JR, Ditchfield A, Cooper JA, Weller RO. Giant tumefactive perivascular spaces. AJNR Am J Neuroradiol. 2005; 26(2): 298 – 305.
  7. Cerase A, Vallone IM, Muccio CF, Petrini C, Signori G, Venturi C. Regression of dilated perivascular spaces of the brain. Surg Radiol Anat. 2010; 32(6): 555 – 61.
  8. Heier LA, Bauer CJ, Schwartz L, Zimmerman RD, Morgello S, Deck MD. Large Virchow-Robin spaces: MR-clinical correlation. AJNR Am J Neuroradiol. 1989; 10(5): 929 – 36.
  9. Zhu YC, Tzourio C, Soumare A, Mazoyer B, Dufouil C, Chabriat H. Severity of dilated Virchow-Robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study. Stroke. 2010; 41: 2483 – 90.
  10. Shiratori K, Mrowka M, Toussaint A, Spalke G, Bien S. Extreme, unilateral widening of Virchow-Robin spaces: case report. Neuroradiology. 2002; 44: 990 – 2.
  11. Rawal S, Croul SE, Willinsky RA, Tymianski M, Krings T. Subcortical cystic lesions within the anterior superior temporal gyrus: a newly recognized characteristic location for dilated perivascular spaces. AJNR Am J Neuroradiol. 2014; 35(2): 317 – 22.
  12. Saeki N, Sato M, Kubota M, Uchino Y, Murai H, Nagai Y, et al. MR imaging of normal perivascular space expansion at midbrain. AJNR Am J Neuroradiol. 2005: 26(3): 566 – 71.
  13. Elster AD, Richardson DN. Focal high signal on MR scans of the midbrain caused by enlarged perivascular spaces: MR-pathologic correlation. AJR Am J Roentgenol. 156(1): 157 – 60.
  14. Maclullich AM, Wardlaw JM, Ferguson KJ, Starr JM, Seckl JR, Deary IJ. Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry. 2004; 75(11): 1519 – 23.
  15. Zhu YC, Dufouil C, Soumare A, Mazoyer B, Chabriat H, Tzourio C. High degree of dilated Virchow-Robin spaces on MRI is associated with increased risk of dementia. J Alzheimers Dis. 2010; 22(2): 663 – 72.
  16. Papayannis CE, Saidon P, Rugilo CA, Hess D, Rodriguez G, Sica REP. Expanding Virchow Robin spaces in the midbrain causing hydrocephalus. AJNR Am J Neuroradiol. 2003; 24(7): 1399 – 403.
  17. Romi F, Tysnes OB, Krakenes J, Savoiardo M, Aarli JA, Bindoff L. Cystic dilation of Virchow-Robin spaces in the midbrain. Eur Neurol. 2002; 47: 186 – 8.
  18. Schroeder HW, Gaab MR, Warzok RW. Endoscopic treatment of an unusual multicystic lesion of the brainstem: case report. Br J Neurosurg. 1996; 10(2): 193 – 6.
  19. House P, Salzman KL, Osborn AG, MacDonald JD, Jensen RL and Couldwell WT. Surgical considerations regarding giant dilations of the perivascular spaces. J Neurosurg. 2004; 100(5): 820 – 4.

How to Cite

Akbar, M. A., Kamil, M., Moinuddin, F. M., Fujio, S., Hirano, H., Ibrahim, A., Bakhtiar, Y., Arifin, T., Muttaqin, Z., & Arita, K. (2021). Variety in magnetic resonance imaging of enlarged perivascular space: Case reports. Indonesian Journal of Neurosurgery, 4(3).