Sleep and perivascular disruption: An illustrative case of severe sleep apnea, an enlarged Virchow-Robin space, and contralateral asymmetric periodic limb movements

Abstract

Virchow-Robin spaces (VRS) are perivascular spaces that have been associated with impaired glymphatic function, poor sleep quality and sleep disorders. These spaces are also associated with neurological impairment. We report a case of a young adult male who presented with severe untreated sleep apnea, shift-work disorder, and excessive asymmetric periodic limb movements disorder in association with a prominent radiologically-identified VRS in the contralateral basal ganglia. This case illustrates the complex “chicken and egg” association between impaired sleep, the development of VRS, and subsequent sleep disorder most likely attributable to the development of this perivascular abnormality.