Editors' note: Teaching NeuroImages: A rare case of giant perivascular spaces in the midbrain manifesting as atypical parkinsonism

Abstract

In “Teaching NeuroImages: A rare case of giant perivascular spaces in the midbrain manifesting as atypical parkinsonism,” the authors present a patient with atypical parkinsonism due to dilated Virchow-Robin spaces and propose that some of the patient's symptoms were secondary to dopaminergic pathway degeneration due to midbrain compression. Dr. Bhattacharjee comments that SPECT imaging, such as dopamine transporters scan (DaT-SPECT scan), would have been helpful in this patient's case to support the authors' hypothesis and rule out vascular parkinsonism. Author Ferrer responds that they did not perform a DaT-SPECT scan on this patient because they did not feel it would be useful, as several published cases of patients with parkinsonism due to dilated Virchow-Robin spaces and abnormal DAT scans have been reported. He also notes that the patient's clinical situation has not deteriorated over many years of follow-up and was never responsive to levodopa. In “Teaching NeuroImages: A rare case of giant perivascular spaces in the midbrain manifesting as atypical parkinsonism,” the authors present a patient with atypical parkinsonism due to dilated Virchow-Robin spaces and propose that some of the patient's symptoms were secondary to dopaminergic pathway degeneration due to midbrain compression. Dr. Bhattacharjee comments that SPECT imaging, such as dopamine transporters scan (DaT-SPECT scan), would have been helpful in this patient's case to support the authors' hypothesis and rule out vascular parkinsonism.