GIANT VIRCHOW ROBIN SPACES WITH TRIVENTRICULAR HYDROCEPHALUS- A CASE REPORT

Abstract

Virchow Robin Spaces (VRS) are peri-vascular spaces which are fluid-filled spaces, pial-lined, accompanying perforating arteries and venules. Dilated VRS occur in three characteristic locations-type I VRS along the lenticulo-straite arteries entering the basal ganglia through the anterior perforating substance, type II VRS seen over the high convexities along the course of perforating medullary arteries as they enter the cortical gray matter and extend into the white matter and type III VRS in mid-brain.  Expanding lacunae, giant or tumefactive Virchow Robin spaces in brainstem are rare and may cause of benign aqueductal obstruction with resultant proximal triventricular hydrocephalus. We report a case of 48-year old hypertensive patient who presented with giddiness, frontal headache, swaying towards right side with diplopia in right eye. MRI brain showed enlarged Virchow Robin spaces in pons and mid-brain on left side extending to left thalamus and left brachium pontis causing compression over fourth ventricle and aqueduct with proximal obstructive dilatation of both lateral ventricles and third ventricle.