Giant mesencephalothalamic VR spaces and obstructive hydrocephalus
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.