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Dear editor, Brain perivascular spaces (PVSs) or Virchow-Robin spaces are pial-lined, interstitial fluid-filled structures surrounding the arteries entering brain parenchyma. Enlarged PVSs are radiological manifestation of posttraumatic encephalopathy and a common biomarker of small vessel disease (SVD). Exuberant forms of PVSs are rarely reported. A 55-year-old male truck driver, retired professional boxer with a history of severe untreated hypertension, obesity, brainstem lacunar stroke, dyslipidemia, heavy smoking, right sided severe internal carotid stenosis (SICS) (90–99%) and hyperhomocysteinemia was brought to the emergency room because of sudden onset of right hemiparesis followed by focal complex hemiconvulsion. On neurological examination the

Honeycomb-like appearance in the brain of a former boxer with hyperhomocysteinemia, severe carotid disease and hemorrhagic stroke