Abstract Details

Title Unusual Case of Recurrent Falls Secondary to Tumefactive Perivascular Spaces

Topic General Neurology

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-006

Objective Report an unusual case of recurrent falls secondary to obstructive hydrocephalus, attributed to tumefactive perivascular spaces.

Background Perivascular spaces also known as Virchow Robin spaces are benign, fluid-filled structures surrounding blood vessels in the white matter of the brain. They are usually small and not easily identified on brain imaging. Tumefactive Perivascular Spaces (TPVS) are characterized by the significant dilation and enlargement of these perivascular spaces. When the dilation is large enough, they can be visualized on MRI. The appearance of TPVS can resemble the appearance of more serious conditions like brain tumors and demyelinating disease making them clinically significant. Additionally, in 43% of giant TPVS, hydrocephalus can be seen. Obstructive hydrocephalus can be due to a myriad of conditions, but enlarged perivascular spaces is unusual. Most common presentation of obstructive hydrocephalus secondary to TPVS is headaches; however, as our case illustrates, poor balance and recurrent falls can be the presenting complaint.

Design/Methods NA

Results A 36-year-old man with no significant medical history presented to the Emergency Department with recurrent falls and imbalance for 6 weeks. Neurological exam was unremarkable with intact brainstem, normal strength, sensation, and reflexes; but, he had extreme difficulty maintaining a steady posture. MRI showed cystic foci filled with CSF in the right midbrain, cerebral peduncle, thalamus, and dentate nucleus but without transependymal flow on FLAIR sequences, suggestive of chronic TPVS. These lesions were causing mass effect and hence, an obstructive hydrocephalus. DWI and apparent diffusion coefficient sequences did not reveal any signal restriction. The patient was admitted and underwent endoscopic third ventriculostomy. After three months, he showed remarkable improvement of his symptoms.

Conclusions TPVS are oftentimes easily misinterpreted as a sinister process given the complications patients present with. Surgery is the mainstay of treatment and remarkable improvement can be achieved after third ventriculostomy for patients who are symptomatic.

Authors/Disclosures
Zahid Iqbal, MD (Henry Ford Apartments) PRESENTER	Dr. Iqbal has nothing to disclose.
Abdelrahman E. Elfaham, MBBS (Henry Ford Hospital)	Dr. Elfaham has nothing to disclose.
Ammar A. Jumah, MD	Dr. Jumah has nothing to disclose.

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