Giant tumefactive perivascular spaces: an incidental finding
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NEURO-IMAGES
Giant tumefactive perivascular spaces: an incidental finding Pretty Sara Idiculla1 · Dhineshreddy Gurala2 · Junaid Habib Siddiqui1 Received: 25 July 2020 / Accepted: 17 August 2020 © Belgian Neurological Society 2020
Keywords Giant tumefactive perivascular spaces · Perivascular spaces of the brain · Incidental neuroimaging findings · Asymptomatic perivascular spaces
Introduction Giant Tumefactive Perivascular Spaces (GTPVS) occur due to exponential enlargement of the perivascular spaces of the brain. We present the case of a 79-year-old female with GTPVS found incidentally on brain MRI (magnetic resonance imaging). This is a particularly interesting case in that she had no clinical symptoms considering the multiplicity, size, and location of the lesion.
was non-focal, other than the bilateral sensorineural deficit. We gave her a diagnosis of incidental Giant Tumefactive Perivascular Spaces (GTPVS). Since she had no associated clinical symptoms or signs, she was reassured about her imaging findings. Though the patient had a large lesion, we decided to manage her conservatively by educating the patient to obtain annual MRI for detecting the development of any new lesions and to monitor the growth of the preexisting lesions.
Case report
Discussion
A 79-year-old Caucasian female presented with complaints of gradually progressive hearing loss in both her ears, left more than the right of 7 years duration. Over the last 6 months, she has noticed worsening symptoms associated with bilateral ear fullness and tinnitus and was evaluated by an ENT (ear, nose, throat) specialist. External and internal ear examination appeared to be normal bilaterally. An audiogram showed a bilateral sensorineural hearing loss, worse on the left than right. Since she was experiencing a recent worsening of symptoms, an MRI of her head was obtained and revealed multiple non-enhancing cystic lesions in the right basal ganglia, thalamus, temporal lobe, and cerebral peduncle, with minimal mass effect on the third ventricle, consistent with prominent perivascular spaces (Fig. 1). She denied any headaches, vision changes, balance difficulties, or any motor weakness, and her neurological examination
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 vess
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