Large anterior temporal Virchow-Robin space

Case contributed by A.Prof Frank Gaillard

Presentation

Headaches. For investigation.

Patient Data

Age: 65 years
Gender: Male
Modality: MRI

An ovoid cystic lesion without enhancement, diffusion restriction or significant mass effect in the anterior left temporal lobe near the Sylvian cistern has a moderate rim of surrounding T2 FLAIR hyperintensity. Occasional punctate T2 FLAIR hyperintense focus in the supratentorial white matter within age-appropriate limits.

The lobulated irregular shaped delayed enhancing right pituitary lesion measuring up to 1.8cm encasing the right cavernous carotid artery with remodelling of the roof or with extension into the right sphenoid sinus is unchanged. The infundibulum is again slightly in shifted to the left. Normal cavernous carotid flow void preserved. Chiasm uninvolved.

Conclusion

Previously reported cystic left anterior temporal lesion measures smaller than the report from 8 years ago (not shown), but is larger than the report form 5 years ago (also not shown). It is characteristic of an anterior temporal lobe perivascular space

Previously reported right pituitary adenoma invading cavernous sinus is stable compared scans from 5 years ago.​

MRI 2 years later

Modality: MRI

The cystic lesion in the left temporal lobe with no solid or enhancing component has a very thin rim of gliosis. When compared to the previous MRI , the cystic cavity is similar in size but the previously identified adjacent T2 hyperintensity has reduced.

The hypo enhancing lesion in the right side of the pituitary is unaltered in size. 

MRI 3 years later

Modality: MRI

Appearances of the left temporal lobe cystic lesion are unaltered with only a small amount of adjacent gliosis/oedema and no contrast enhancement or calcification. Incidental note is made of an 8mm pineal cyst, also unaltered.

The right sided hypoenhancing pituitary lesion is unchanged in size. There is extension into the right cavernous sinus and sphenoid sinus. The infundibulum is deviated to the left.​

Case Discussion

Anterior temporal lobe perivascular spaces are an important entity to be aware of. Unlike perivascular spaces elsewhere they can have oedema and change in size. The adjacent 'knuckle' of MCA branch is characteristic. 

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Case Information

rID: 38659
Case created: 28th Jul 2015
Last edited: 20th Apr 2017
Inclusion in quiz mode: Included

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