Giant mesencephalothalamic VR spaces and obstructive hydrocephalus

Discussion:

The typical CSF signal and normal adjacent brain parenchyma as well as lack of soft tissue component and post-contrast enhancement allow a confident diagnosis of giant  virchow Robin (VR) spaces. It is also helpful that the patient has had this finding for almost a decade without change. 

 The differential diagnosis of dilated VR spaces include lacunar infarctions ( with perilesional gliosis), multiple sclerosis, neurocysticercosis, cystic neoplasms e.g. pilocytic astrocytoma ( with small solid component and post contrast enhancment of the cystic wall and the solid component), mucopolysaccharidoses e.g. Hurler's syndrome as well as neuroepithelial and arachnoid cysts.    

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