Multiple thin-walled cystic spaces are seen; predominantly at the right midbrain and right hypothalamus as well as the right thalamus and basal ganglia. They present isointense signal to the CSF on all pulse sequences with no significant post-contrast enhancement. Similar lesions are seen within the left midbrain and basal ganglia. The lesions are seen surrounding and significantly compressing the cerebral aqueduct with consequent moderate dilatation of the ventricular system. normal adjacent brain parenchyma. No area of restricted diffusion. Prominent extra-axial CSF spaces. No extra-axial collections. Partial empty sella with intra-sellar herniation of the supra-sellar cistern with widened sella turcica and the pituitary gland is seen flattened against the sellar floor.
Diagnosis: Expanding and giant Virchow-Robin spaces; predominantly within the right midbrain, hypothalamus, thalamus and basal ganglia (mesencephalothalamic giant VR spaces) with mass effect on the cerebral aqueduct and supratentorial obstructive hydrocephalus.