Abstract Details

Title Abnormal Enlargement of Virchow-Robin spaces resulting in Paresthesia and Weakness

Topic General Neurology

Presentation(s) General Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 069

Objective We present a case of a patient who experienced approximately two years of persistent neurologic symptoms, including left arm paresthesias and left leg weakness. Neuroimaging ultimately showed multiple right hemispheric cystic-appearing lesions consistent with enlarged Virchow-Robin spaces.

Background Virchow-Robin spaces, also referred to anatomically as perivascular spaces, are fluid-filled structures located around the lining of cerebral vessels as they traverse the brain. The gradual enlargement of these spaces is part of the normal aging process, however disproportional dilatation can be of clinical significance.

Design/Methods N/A

Results

A 58-year-old woman was referred to outpatient neurologist for persistent left hand numbness and gait abnormality. She was initially seen two years ago by orthopedics for left hand numbness and mild weakness. It was felt to be carpal tunnel syndrome, and she underwent release surgery but symptoms persisted. She then developed contracture of first three digits of left hand and underwent a trigger release procedure. She was referred to Physical Therapy, who recommended neurologic evaluation for gait abnormality.

On neurologic evaluation, she had left hemiplegic gait with mild clawing/contracture of left hand, and spasticity on left arm flexion. Magnetic resonance imaging (MRI) of the brain showed multiple cystic lesions in the right midbrain, thalamus, and corona radiata. These lesions did not exhibit any pathologic contrast-enhancement, and were felt to be most consistent with enlarged Virchow-Robin spaces.

Conclusions Abnormal enlargement of Virchow-Robin spaces can cause dysfunction of surrounding intraparenchymal structures. Our patient had left-sided neurologic symptoms that failed to resolve after surgery, prompting further workup to rule out central causes. Brain MRI showed enlarged Virchow-Robin spaces within the right midbrain, thalamus, and corona radiata. These findings likely explain her presenting symptoms, and further neurosurgical consultation is pending.

Authors/Disclosures
Jaspreet Johal, MD PRESENTER	Dr. Johal has nothing to disclose.
Ramiro G. Castro Apolo, MD (Lehigh Valley Health Network)	Dr. Castro Apolo has nothing to disclose.
Negar Moheb, MD (Lehigh Valley Fleming Neuroscience Institute)	Dr. Moheb has nothing to disclose.
	No disclosure on file
Gary W. Clauser, MD (Lehigh Neurology)	Dr. Clauser has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bigoen . The institution of Dr. Clauser has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genzyme. Dr. Clauser has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech . Dr. Clauser has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Genzyme. Dr. Clauser has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Clauser has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Novartid.

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