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AJNR - American Journal of Neuroradiology

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Expanding Virchow Robin Spaces in the Midbrain Causing Hydrocephalus

Cristina E. Papayannis^a, Patricia Saidon^a, Carlos A. Rugilo^b, Diego Hess^a, Gabriel Rodriguez^a, Roberto E. P. Sica^a and Raul C. Rey^a

^a Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina
^b Department of Neuroradiology, Fundación Femién, Buenos Aires, Argentina

View larger version (181K): [in a new window]   FIG 1. Axial T2-weighted images (5400/103 [TR/TE]). Multiple, confluent, hyperintense, cystlike lesions exist in the right thalamo-ponto-mesencephalic region, exerting mass effect and compressing the cerebral aqueduct and the upper half of the fourth ventricle. The arrow shows periventricular edema caused by the obstructive hydrocephalus.

View larger version (177K): [in a new window]   FIG 2. Axial fluid-attenuated inversion recovery images (9002/126/2250[TR/TE/TI]). A subtle hyperintense signal partially surrounds the lesions, compatible with a gliotic reaction.

View larger version (171K): [in a new window]   FIG 3. Coronal T1-weighted MR image (480/14 [TR/TE]). The lesions are isointense with CSF, a finding consistent with noncommunicting hydrocephalus.

View larger version (90K): [in a new window]   FIG 4. A (20 x 20 x 20 mm) proton MR spectrum (2000/144 [TR/TE]) obtained at the level of the mesencephalic cystic formation. A slight increment of Cho with no lactate is shown. This pattern is different from that observed in parasitic or tumor cysts. The increment in Cho could be due to demyelination surrounding the lesions, explained by the mass effect exerted by the spaces adjacent to parenchyma.

View larger version (88K): [in a new window]   FIG 5. Postoperative axial T2-weighted images (5400/103 [TR/TE]). Resolution of hydrocephalus is shown, with no change of the midbrain lesions.