Enlarged Perivascular (Virchow Robin) Spaces

MRI Brain, Axial T2, FLAIR, Diffusion; CT Brain

Findings:
Multiple T2 hyperintense foci cluttered in right parietal white matter and a single in right frontal lobe white matter, complete signal suppression on FLAIR are the enlarged peri vascular spaces.
Hypodense on CT.
Adjacent brain show normal signals. No any evidence of Gliosis.

On CT, the closest differential is lacunar infarcts which can be ruled out by demonstrating absence of surrounding rim of Gliosis on MRI FLAIR.

Enlarged peri vascular spaces also called Virchow Robin spaces.
Typical and commonest location is basal ganglia.
Usually found in clustures.
Iso intense to Csf on all pulse sequences.
May be seen in lobar white matter and even in brain stem.