Intermittent visual field defects caused by a dilated Virchow-Robin space close to the optic radiation: Therapeutic and pathomechanical considerations

Objective. Virchow-Robin spaces (VRSs) are extensions of subarachnoid spaces that accompany vessels entering the brain. T2-weighted magnetic resonance imaging detects VRS in about 95 percent of patients in a recent study. VRSs are considered a normal variant with benign prognosis. 1 Occasionally, VRS might become symptomatic causing neurological deficits depending on their location. 2 Case description. We report the case of a 55-year-old female patient with dilated VRS presenting with visual field disturbances and cognitive deficits. The patient underwent endoscopic fenestration of a large periventricular VRS located next to the visual radiation into the posterior horn of the right lateral ventricle. During the postoperative course, visual field disturbances were resolved but cognitive deficits remained unchanged. Conclusion. Dilated VRSs can cause a variety of neurological deficits depending on their size and location. Therefore, patients harboring dilated VRS should undergo early close inspection and in case of progressive neurological deficits, an operative therapy should be done; as valve mechanisms can cause a reduction of size when brain scans are conducted and later lead to occurrence of severe neurological deficits during phase of dilation.