Cerebrospinal fluid diversion in patients with enlarged Virchow-Robin spaces without ventriculomegaly

Objective Enlarged Virchow-Robin spaces (eVRS) are a MRI biomarker in several neurological diseases of inflammatory, neurodegenerative, vascular, metabolic, 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 & Methods A retrospective study of 7 patients presenting progressive gait, cognitive and urinary disturbances in association with eVRS was undertaken. Results All patients presented 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.