Virchow-Robin space: a path of spread in neurosarcoidosis

Three cases of documented sarcoid meningoencephalitis were reviewed. Computed tomography (CT) showed enhancing, perivascular, linear, and nodular areas along the subarachnoid space, extending deep into the white matter. In one case the perivascular granulomatous infiltration, which caused small vessel periangiitis, gave rise to a CT pattern closely resembling that of arteriovenous malformation or infarction with gyral enhancement. This infiltrative pattern might be seen in other chronic meningeal processes. The pathophysiology responsible for the unusual CT appearance and the differential diagnosis are discussed.