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Cerebrospinal fluid diversion in patients with enlarged Virchow‐Robin spaces without ventriculomegaly
Author(s) -
Scollato A.,
Gallina P.,
Di Lorenzo N.
Publication year - 2016
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12419
Subject(s) - ventriculomegaly , medicine , cerebrospinal fluid , hydrocephalus , subarachnoid space , lumbar , surgery , magnetic resonance imaging , radiology , pregnancy , fetus , genetics , biology
Objective Enlarged Virchow‐Robin spaces ( eVRS ) are an MRI biomarker in several neurological diseases of inflammatory, neurodegenerative, vascular, metabolic, or genetic origin. We report on a further condition in which eVRS were observed in patients with an ongoing chronic hydrocephalus‐like clinical picture without ventriculomegaly who improved after CSF diversion, and we discuss the possible mechanisms underlying this finding. Materials and methods A retrospective study of seven patients presenting progressive gait, cognitive, and urinary disturbances in association with eVRS was undertaken. Results All patients presented an Evans ratio <0.30 and >20 eVRS at the level of basal ganglia and periventricular parenchyma as assessed by T2‐weighted MRI . All patients underwent prolonged external lumbar drainage ( PELD ) with good response. Six patients received ventriculoperitoneal shunt with improvement of their clinical status compared to that before PELD (follow‐up: 8–58 months, mean 24.6). The seventh patient did not undergo ventriculoperitoneal shunt and received a second PELD with persistent improvement (follow‐up: 14 months). Conclusions Our results indicate that a mechanism involving CSF accumulation and stasis in the subarachnoid space was at least a concurrent factor of this clinical picture. This study should stimulate new perspectives on the role of CSF disturbances in the pathogenesis of diseases associated with VRS enlargement.