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Dementia With Extensive Giant Perivascular Spaces as a Mimicker of Alzheimer Disease: A Case Report

Aliakbar Netterwala1, Thomas Mathew1, Allen Johnson2

  • 1Department of Neurology.

Alzheimer Disease and Associated Disorders
|August 19, 2026
PubMed

Insights

Giant perivascular spaces (PVS) are rare causes of cognitive decline. This case report shows extensive giant PVS mimicking Alzheimer disease, suggesting PVS burden may contribute to late-life cognitive impairment.

Area of Science:

  • Neurology
  • Radiology
  • Geriatrics

Background:

  • Giant perivascular spaces (PVS) are typically incidental findings on brain MRI.
  • Rarely, PVS can be associated with progressive cognitive decline.

Purpose of the Study:

  • To report a case of a 70-year-old woman with progressive cognitive decline attributed to extensive giant PVS.
  • To highlight giant PVS as a potential mimic of Alzheimer disease.

Main Methods:

  • Case report of a 70-year-old woman with a 3-year history of amnestic dementia.
  • Brain MRI showing extensive bilateral giant cystic spaces consistent with PVS.
  • Exclusion of reversible causes and negative Alzheimer pathology biomarkers (p-tau217/Aβ1-42).

Main Results:

  • The patient presented with progressive amnestic dementia and multidomain cognitive deficits.
  • MRI revealed extensive bilateral giant PVS in white matter.
  • Biomarker evaluation excluded typical Alzheimer disease pathology.

Conclusions:

  • Giant PVS can present as a cause of progressive cognitive impairment.
  • This case underscores the importance of considering giant PVS in the differential diagnosis of dementia, especially when mimicking Alzheimer disease.
  • A significant PVS burden may contribute to late-life cognitive decline.
Keywords:
Alzheimer diseasecognitive impairmentgiant perivascular spacesmagnetic resonance imagingplasma p-tau217/Aβ1-42 ratio

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