Can Isolated Enlarged Virchow-Robin Spaces Influence the Clinical Manifestations of Parkinson's Disease?

Abstract

Dilated Virchow‐Robin (VR) spaces are usually not considered to be symptomatic. We present three cases presenting with atypical clinical features, which otherwise had clinical/imaging findings consistent with idiopathic Parkinson's disease. In all cases, an isolated large VR space in the basal ganglia contralateral to the side of symptom onset was observed. We propose that the atypical features could be associated with the mass effect of a significantly enlarged VR space, which would cause a dysfunction downstream from the presynaptic nigrostriatal dopaminergic system.

Perivascular Unit: This Must Be the Place. The Anatomical Crossroad Between the Immune, Vascular and Nervous System

“…In the context of neurodegenerative disorders, parkinsonism with enlarged PVS in basal ganglia has been reported by several authors through the years (Fenelon et al, 1995;Mancardi et al, 1998;Duker and Espay, 2007;Mehta et al, 2013;Lee et al, 2015b). Their clinical significance remains unclear but in recent articles enlargement of PVS was found to be predictive of cognitive impairment in PD (Park et al, 2019;Shibata et al, 2019) and related to motor symptoms (Laitinen et al, 2000;Mestre et al, 2014;Lee et al, 2015a;Conforti et al, 2018;Wan et al, 2019). However, the validation of these observations is lacking, and the mechanisms by which enlarged PVS negatively affect motor and cognitive changes in PD remain largely unknown (see Table 2).…”

Simultaneous Classical and Holmes’ Tremor in Parkinson’s Disease: Involvement of the Cerebellum

“…Three cases presenting with atypical clinical features of PD associated with the mass effect of a significantly enlarged pre-existing Virchow-Robin space have been reported. 5 Our case had a pre-existing cerebellar dysfunction, and the HT developed after the appearance of PD. A few patients have been reported with HT caused by pre-existing cerebellar dysfunction and subsequent nigrostriatal deficit.…”

Dilated Virchow-Robin space and Parkinson's disease: A case report of combined MRI and diffusion tensor imaging

“…In 2014, Mestre et al. presented 3 cases with atypical clinical features, which were affected by idiopathic PD [12] . In all cases, an isolated large VRS in the basal ganglia contralateral to the side of symptom onset was observed, similar to our patient.…”

“…In all cases, an isolated large VRS in the basal ganglia contralateral to the side of symptom onset was observed, similar to our patient. The authors propose that the atypical features could be associated with the mass effect of a significantly enlarged VRS, which would cause a dysfunction downstream from the presynaptic nigrostriatal dopaminergic system [12] . The authors conclude, stating that the seemingly rare finding of a single enlarged VRS in PD suggests that the underlying mechanism expanding VRS in these patients is likely independent from the neurodegenerative process ongoing in PD [12] .…”