Atypical Lesions in Virchow-Robin Spaces: A Case Report

The differentiation between benign and malignant brain lesions remains a fundamental challenge in modern neuroimaging. This case highlights a rare presentation of ectatic Virchow-Robin spaces (VRS), which mimicked tumefactive brain lesions and required a comprehensive diagnostic evaluation to exclude neoplastic, infectious, and inflammatory processes. A 37-year-old female presented with progressive headache, cognitive impairment, and facial pain. Magnetic resonance imaging revealed a multiloculated subcortical cystic lesion, initially raising suspicions of a dysembryoplastic neuroepithelial tumor or neurocysticercosis. Advanced imaging modalities, including MR spectroscopy and MR angiography, played a crucial role in confirming the benign nature of the lesion. This report underscores the critical role of a multidisciplinary diagnostic approach, integrating clinical presentation, imaging characteristics, and laboratory findings, to address the diagnostic overlap between benign dilated VRS and pathological conditions such as tumors or infections. Additionally, the case emphasizes the importance of recognizing atypical presentations of VRS to avoid unnecessary interventions and to guide patient-centered management.