Author response: Teaching NeuroImages: A rare case of giant perivascular spaces in the midbrain manifesting as atypical parkinsonism.

Abstract

We appreciate the comments of Dr. Shakya Bhattacharjee on our Teaching NeuroImage.1 Certainly, the present case raises concern about the final reason for this parkinsonism. We did not carry out dopamine transporter (DaT) SPECT scan because we did not think it would be of substantial help to understand the nature of our patient's parkinsonism. DaT SPECT is a useful tool, but is not the gold standard for parkinsonism diagnosis.2,3 DaT scan can also be abnormal in secondary parkinsonisms, such as vascular or mass-related parkinsonism.3,4 In any case, there are at least 3 published cases with parkinsonism associated to dilated Virchow-Robin spaces and abnormal DaT scan.5,6 Another case, with reviewed and updated information, including DaT status of several cases, was published last year.7