Multicystic Perivascular Spaces Mimicking Cystic Neoplasm of Brain

Background: Virchow-Robin (VR) spaces are the fluid-filled perivascular spaces adjacent the brain vessels. The signal intensities of the VR spaces are very similar to those of cerebrospinal fluid (CSF). VR spaces should be distinguished various pathologic conditions, including lacunar infarctions, cystic periventricular leukomalacia, cryptococcosis, cystic neoplasms and neuroepithelial cysts. Case presentation: 32-year-old female with 6 month history of worsening severe headaches. The clinical examination and laboratory findings were congruent with hypothyroidism. MR imaging revealed multiloculated, thin-walled, “soap bubble” like lesions cystic lesions involving anterior part of left cingulated gyrus. Cystic lesions showed the same signal intensity characterstics with CSF. There was no any mass effect, enhancement, peripheral edema and no restriction in diffusion-weighted images. After 10 month follow-up there was no any change in size or in MRI features. Conclusion: Knowledge of the signal intensity characteristics, locations of VR spaces and absence of any change in follow up prevents unnecessary biopsy.