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Giant Virchow-Robin spaces

Case contributed by Ahmed Abdrabou
Diagnosis almost certain

Presentation

History of recent head trauma and found incidental finding on CT.

Patient Data

Age: 30 years
Gender: Male
ct

Right frontal cortical and subcortical hypodense lesion with associated focal thinning of the frontal bone suggesting long standing lesion. 

mri

A right frontal subcortical multicystic area that displays CSF signal intensity in all pulse sequences with no significant mass effect, diffusion restriction or post-contrast enhancement. 

Case Discussion

Dilated perivascular spaces are usually incidentally discovered. In most cases they are small and cyst-like yet in few cases they enlarge, acquire bizarre shape and mistaken for tumors. Sometimes they may cause mass effect. Here is a nice example of giant type II perivascular spaces. 

The differential diagnosis includes:

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