Giant tumefactive perivascular spaces: A case report.

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Background:

• Perivascular spaces are interstitial fluid-filled regions crucial for CNS lymphatic drainage and immune function.
• Enlarged perivascular spaces are termed giant tumefactive perivascular spaces.
• These entities are frequently misdiagnosed as cystic neoplasms, necessitating high clinical suspicion for accurate diagnosis.

Observation:

• A 32-year-old man presented with worsening headache, blurred vision, and photophobia.
• Initial neuroimaging revealed hydrocephalus and enlarged cystic spaces, raising concern for neoplasm.
• Outpatient follow-up with a neurosurgeon identified characteristic features of giant tumefactive perivascular spaces.

Findings:

• Giant tumefactive perivascular spaces are benign and often present with headache.
• Key diagnostic radiologic features include smooth margins, isointensity to cerebrospinal fluid, and absent postcontrast enhancement.
• Characteristic imaging findings can prevent misdiagnosis and unnecessary invasive procedures.

Implications:

• Accurate identification of giant tumefactive perivascular spaces avoids misdiagnosis as neoplastic lesions.
• Recognizing specific radiological features is critical for appropriate patient management.
• Timely diagnosis prevents unnecessary biopsies and surgical interventions, reducing patient morbidity.