Fellows’ Journal Club
February 2014
(2 of 3)
Fifteen patients with unusual dilated perivascular spaces in the subcortical white matter of the anterior superior temporal gyrus were presented. In one, pathology showed gliosis and innumerable perivascular spaces. Findings that suggest cysts in this location were perivascular spaces include: lack of symptoms, proximity to the subarachnoid space, adjacent blood vessels, and stability over time.
Summary
Cystic parenchymal lesions may pose an important diagnostic challenge, particularly when encountered in unexpected locations. Dilated perivascular spaces, which may mimic cystic neoplasms, are known to occur in the inferior basal ganglia and mesencephalothalamic regions; a focal preference within the subcortical white matter has not been reported. This series describes 15 cases of patients with cystic lesions within the subcortical white matter of the anterior superior temporal lobe, which followed a CSF signal; were located adjacent to a subarachnoid space; demonstrated variable surrounding signal change; and, in those that were followed up, showed stability. Pathology study results obtained in 1 patient demonstrated chronic gliosis surrounding innumerable dilated perivascular spaces. These findings suggest that dilated perivascular spaces may exhibit a regional preference for the subcortical white matter of the anterior superior temporal lobe. Other features—lack of clinical symptoms, proximity to the subarachnoid space, identification of an adjacent vessel, and stability with time—may help in confidently making the prospective diagnosis of a dilated perivascular space, thereby preventing unnecessary invasive management.
