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Obstructive Hydrocephalus Caused by Tumefactive Perivascular Spaces: A Case Report
Joaquin Ruiz Lopez1, Adriana M Perez Torres1, Claudia M Muns1
1Department of Radiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
The American Journal of Case Reports
|June 26, 2025
Summary
Enlarged perivascular spaces (PS) can mimic serious brain conditions, leading to diagnostic challenges. Accurate MRI interpretation is crucial to distinguish these benign spaces from dangerous pathologies and avoid misdiagnosis.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Perivascular spaces (PS), or Virchow-Robin spaces, are typically benign fluid-filled regions around cerebral blood vessels.
- Enlarged PS, termed tumefactive PS, are rare and can mimic severe intracranial pathologies, posing diagnostic challenges.
Purpose of the Study:
- To highlight a rare case of tumefactive PS causing obstructive hydrocephalus.
- To emphasize the importance of accurate MRI interpretation for differentiating tumefactive PS from other intracranial diseases.
Main Methods:
- Case report of a 66-year-old female with progressive somnolence and encephalopathy.
- Advanced CT and MRI imaging revealed enlarged PS near the third and fourth ventricles, causing obstructive ventriculomegaly.
- Differential diagnoses included cystic tumors and infections; MRI findings confirmed tumefactive PS due to CSF isointensity and lack of contrast enhancement.
Main Results:
- Significantly enlarged perivascular spaces were identified, causing obstructive ventriculomegaly and mimicking serious intracranial conditions.
- MRI findings, including cerebrospinal fluid (CSF) isointensity and absence of contrast enhancement, were key in diagnosing tumefactive PS.
- The patient's condition deteriorated due to sepsis and abscess, leading to death before surgical intervention for hydrocephalus could be performed.
Conclusions:
- Tumefactive PS, though rare, can present as a diagnostic challenge, mimicking severe intracranial pathologies.
- Accurate MRI evaluation, focusing on vessel alignment, lack of enhancement, and CSF signal intensity, is crucial for correct diagnosis.
- Misdiagnosis of tumefactive PS can lead to unnecessary procedures; prompt and precise diagnosis is vital for effective management of symptomatic cases.
