Midbrain enlarged perivascular spaces

Case contributed by Dr Bruno Di Muzio

Presentation

Previous history of breast and prostate cancer. First episode of focal epilepsy.

Patient Data

Age: 66
Gender: Male

MRI brain (3T - TLE protocol)

MRI

A few tiny T2 hyperintense white matter foci within the range of normal for age. No diffusion restriction or susceptibility artefact. In the left midbrain, circumscribed CSF signal foci traversed by linear structures have a location appearance typical of prominent perivascular space rather than lesion.

No intra or extra-axial mass or pathological contrast enhancement.

The grey-white matter junction and appearance of the cortex is unremarkable, with no evidence of cortical dysplasia or grey matter heterotopia.

The mesial temporal lobes, including the hippocampi, are unremarkable in size and morphology, allowing for subtle movement artefact on the coronal T2 sequence.​

Annotated image

A few tiny T2 hyperintense white matter foci within the range of normal for age. No diffusion restriction or susceptibility artefact. In the left midbrain, circumscribed CSF signal foci traversed by linear structures have a location appearance typical of prominent perivascular space rather than lesion.

Case Discussion

This case illustrates a left midbrain lesion that has appearance typical of prominent perivascular space rather than lesion. It is important to note that perivascular spaces follow CSF signal on all pulse sequences. 

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