Unusual dilatation of Virchow-Robin spaces: case report

Virchow-Robin spaces normally surround the perforating arteries that enter the brain. These spaces are a well-defined sites where immunological reactions take place and they may have implications in the pathogenesis of a number of neuropathological conditions. We present the case of a 52-year-old woman who had a history of complex partial seizures for 30 years. Her routine neurological examinations and mini-mental tests had normal results. Magnetic resonance images of this patient revealed unusual widening of the Virchow-Robin spaces up to 1.5 cm in diameter along the perforating medullary arteries in the white matter, more so in the left hemisphere. Although it has been concluded that these large spaces are a phenomenon of the normal aging brain and are unrelated to neurological diseases, our patient had had epileptic seizures for 30 years. The large Virchow-Robin spaces of our patient might have been an incidental radiologic finding. Their pathogenesis remains unclear, and their possible clinical relationship to epilepsy deserves further pathological studies.