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Virchow−Robin腔の拡大がみられた2小児例
木村, 清次
東京女子医科大学雑誌, 63(臨時増刊):E11-E14, 1993
http://hdl.handle.net/10470/8941
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11
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LARGE VIRCHOW-ROBIN SPACES IN TWO CHILDREN
Seiji KIMURA
Department of Pediatrics, Yokohama City University School of Medicine
(Received June 22, 1993)
Large symmetrical Virchow--Robin spaces in the bilateral cerebral white matter,
dominant in the occipital area, were observed in two children on magnetic resonance
imaging. Large Virchow-Robin spaces have been reported as non-specific white matter
lesions, which are sometimes misdiagnosed as lacunar infarcts, and have been seen
mainly in the aging brain. To our knowledge, there has been no report of large
Virchow-Robin spaces in young children. We present herein the cases of two children
with large Virchow-Robin spaces who developed generalized seizures. Each patient had
had an episode of perinatal asphyxia.
serum and for urinary organic acids was negative.
Introduction
Case 2. A 3-year-old boy; born at 25 gestational
The Virchow-Robin space is a subadventitial
space that encircles capillaries in the central
nervous system (CNS). Recently, dilated Virchow--
Robin spaces have been visualized ･by magnetic
resonance <MR) imagingi)N3). Large Virchow-Robin
spaces are seen in the brain in association with
aging and miscellaneous conditions3}N7). We herein
present our experience of prominent VirchowRobin spaces in two children with generalized
weeks with a body weight of 688 g. The patient
was mechanically ventilated at birth. The serum
IgM at birth was 54 mg/dl (normal <20). A chest
radiograph at 7 days was consistent with the
Wilson-Mikity syndrome. Mechanical ventilation
and oxygen therapy were terminated at days 93
and 240, respectively. The patient developed a
generalized seizure at age 1 1/2 and also speech
disability, though his motor development was
normal. His speech disability improved until the
seizure disorder.
age of 5, and his IQ at the age of 6 was 98.
Case Reports
MR Studies
Case 1. A 5-year-old boy; born to non-consanguineous healthy parents with a body weight of
Case 1. An MR scan of the brain was obtained at
3,206 g at 41 gestational weeks, turbid amniotic
age 5. The general configuration of the brain was
fluid and initial tachypnea and cyanosis which
well preserved, though parallel linear or tubular
disappeared by day 3 after birth without supple-
lesions were demonstrated. These lesions showed
low and high intensity attenuation on Ti (TR/TE
mental oxygen therapy. Developmental milestones
were normal. At age 5, he developed a generalized
==440/15) and T2 (TR/TE=2500/100) weighted
motor seizure disorder. He had no intracranial
'
pyramidal or extrapyramidal signs. The verbal IQ
was 87 while the performance IQ was 100. Routine
images, respectively (Fig. 1-1-4). The lesions were
laboratory examinations including serum chemis-
bilaterally, mainly in the occipital area (Fig. 1-
isointense relative to the cerebrospinal fluid. Ab-
normalities were found in the white matter
tries and cerebrospinal fluid analysis showed no
lt-3). Lesions were oriented vertically between the
abnormalities. Screening for amino acids, lyso-
periventricular white matter and the subcortices
somal enzymes, and long chain fatty acids in the
(Fig. 1-4). Branches emanating from these lesions
-Ell-
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Flg. 1 MRIofPatient1
Multiple low intensity tubular lesions are seen in the bilateral occipital white matter (arrowheads), almost
symmetrically, on a Ti (TRITE =440115) image (1). On a T2 (TRITE =25001100) image, tubular lesions
showing isointensity with cerebrospinal fluid are remarkably more visible (arrowheads) than these on a Ti
image. Thin linear high intensity lesions show a parallel arrangement, and some linear lesions are
connected with cerebral cortices as indicated by arrows (2). Low intensity spotty lesions are dominant in
the occipital area (arrowhead) (TRITE=45/13) (3). On a sagittal section (T2 image), the parallel
arrangement of tubular lesions is more remarkable than that seen on other sections (arrowheads). They
run vertically between periventricular white matter and cortices (arrowheads) (4).
were connected to the subarachnoid space of the
arrangement of linear or tubular lesions in the
cortical surface (Fig. 1-2). On MR angiography
there was no arteriovenous malformation.
cerebral white matter. Abnorrnalities were 1ocated
Case 2. MR findings were similar to those of
nent in the occipital area. Lesions showed low and
throughout the cerebrum, but were most promi-
Case 1 (Fig. 2--5, 6), though the lesions were less
high intensities by Ti- and T2-weighted imaging,
prominent than in Case 1. Tubular or linear
respectively, and were isointense relative to the
lesions were located only in the occipital white
cerebrospinal fluid. In some of the MR scan slices,
matter.
Follow up MR studies performed one year after
continuity of these lesions with the subarachnoid
the first examinations of both patients showed no
lesions were consistent with large Virchow-Robin
spaces of the cerebral cortices was visible. These
interval change.
spacesi}N3). Large Virchow-Robin spaces have been
reported in the aging brain and in miscellaneous
Discussion
MR
conditionsi}N7), but most are non-specific white
scans of two children revealed a parallel
matter lesions. A recent study by Heier et a13)
-E12-
13
Fig. 2 MRIofPatient2
On a T2 image, tubular lesions showing isointensity with cerebrospinal fluid are present (arrows). These
lesions are almost same as those seen in Fig. I--2 of Patient 1 (5). A sagittal section (T2 image) shows the
parallel arrangement of tubular lesions. They run vertically between the periventricular white matter and
cortices (6).
concluded that large Virchow-Robin spaces are
another phenomenon of the aging brain. A large
References
Virchow-Robin space is sometimes mistaken for a
1) Jungreis CA, Kanal E, Hirsch W et al; Normal
lacunar infarctioni}2). In the present cases, the
lesions were symmetrical in the two hemispheres
and were isointense relative to the cerebrospinal
fluid. Abnormalities were vertically oriented be-
tween the periventricular white matter and the
cerebral cortices. These findings are consistent
with Virchow-Robin spaces rather than lacunar
infarctioni)ny3). Both of our patients had experi-
enced perinatal asphyxia of mild degree, though
Patient 2 had required mechanical ventilation for
about 3 months. Perinatal asphyxia causes miscellaneous white matter lesions, which are easily
recognized by MR scan if the lesions are marked.
However, brain lesions caused by mild perinatal
asphyxia are not well understood, because normal
children without a history of perinatal asphyxia
are rarely examined by MR scans. Mild diffuse
brain atrophy, a sequela of mild perinatal asphyxia, may cause large Virchow-Robin spaces,
which may mimic the atrophy seen in the aging
brain.
-E13-
perivascular spaces mimicking lacunar infarction: MR
imaging. Radiolczgy 169: 101-104, 1988
2) Braffman BH, Zimmerman RA, Trojanowski JQ
et al: Pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin
spaces. AJNR 151: 551-558, 1988
3) Heier LA, Bauer CJ, Schwartz L et al: Large
Virchow-Robin spaces: MR-clinical correlation. AJNR
10: 929-936, 1989
4) Mirfakhraee M, Crofford MJ, Guinto FC et al: A
path of spread in neurosarcoidosis. Radiology 158:
715-720, 1986
5) Wehn SM, Heinz ER, Burger PC et al: Dilated
Virchow-Robin spaces in cryptococcal meningitis asso-
ciated with AIDS: CT and MR findings. J Comput
Assist Tomogr 13: 756-762, 1989
6) Sheerman JL, Stern BJ: Sarcoidosis of the CNS:
Comparison of unenhanced and enhanced MR images.
AJNR 11: 915-923, 1990
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14
virchow・Robin腔の拡大がみられた2小児例
横浜市立大学医学部附属浦舟病院小児科
キムラ セイ ジ
木村 清次
MRIで顕著なVirchow−Robin腔の拡大が認められた2小児例を報告した．病変は大脳両側対称性
であり，後頭葉に顕著であった．画像上は小梗塞との鑑別が必要であるが，大脳に左右対称性に認め
られること，病変が線状∼管状で大脳深部と脳表間に平行に存在することなどから，小梗塞とは鑑別
が可能であった．Virchow・Robin腔の拡大は主に老人の脳にみられ非特異的な所見と考えられてい
る．小児では今回の症例に見られるような顕著な拡大例の報告はない．今回の2症例共に既往に周産
期の軽度の低酸素状態があり，軽度の低酸素状態に伴う軽度の脳実質の萎縮でVirchow−Robin腔が
拡大した可能性がある．
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