Virchow-Robins spaces in early MS?

[Sarahsmom46]

Good Afternoon Dr. Kantor,

What is the significance of Virchow-Robins spaces seen on brain MRIs when looking at a patient with possible MS?  Can they disappear on later MRIs especially when done after a Solumed treatment?  I posted a question to you recently about disappearing lesions and after my neurologist appointment yesterday  (I saw the MS nurse not the doctor) was told that these "disappearing lesions" may have actually been VR.  I got the impression that this is not something seen in MS.  

Thank you for helping with all our questions.

Julie

[Sarahsmom46]

OK, it is linguistics.  Prominent versus dilated, that is a little more understandable.  When I last spoke to the neurologist he told me that the two lesions, and he called them lesions, from the previous 3 MRIs were not visible.  It was the neuro nurse who said they thought those "lesions" might have been VRS.   I'll clear this up with the doctor next week.

Thanks again.

Julie

[Quixotic1]

No, I didn't understand it.  I thought that, while VR spaces were normal findings on anyone's MRI, that your report noted that they were unusually prominent as would be seen in atrophy.

Again, I probably used the wrong word when I said they were said to be more "common" in MS, when I probably should have said more prominent.  In a forum like this we have to be exact in our wording, whereas in the MS forum we can converse and ask back and forth about what we might mean.

I guess he is saying that he doesn't believe a change in the appearance of the VR spaces (like being larger) would have any bearing on the diagnostic process.

Quix

[Sarahsmom46]

Do you understand Dr. Kantor's response?  I don't know what this means exactly?  Are VRS an aspect of MRI findings on MS?  Maybe seen on MRI in MS? Or not usually something sen on MRI in MS?  Maybe I wasn't stating my question clearly, which often happens.  Thanks.

Julie

[Dr. Daniel Kantor, MD]

Virchow-Robbin (or Virchow-Robin) spaces are normal -- they are dilated perivascular spaces or spaces/voids around blood vessels.
If there is more atrophy or simply a spacious brain there may be more of these spaces, but this is a normal finding on MRI.

There are different imaging sequences on MRI -- most comonly T1, T2 and FLAIR (fluid attenauated inversion recovery) On T1/FLAIR imaging they should be dark and on T2 they should be white (this is because they are the same color as the CSF, cerebrospinal fluid = the fluid surrounding and bathing the brain and spinal cord).\

MS lesions would be no color or dark ("black hole" showing axonal loss) on T1 and white on T2 and FLAIR (because of the "scarring").

[Sarahsmom46]

Hope this question isn't getting lost in the flurry of more questions... Also See Heather's question from Jan 24.  Much thanks!

[Quixotic1]

I, too, would like a comment on VR spaces.  This has come up on the forum and been a cause of concern.

I have found a radiology study that stated thate VR spaces are definitely more common in  MS, possibly due to early brain atrophy.  That study was a few years ago, and I have not seen any follow up to it.  VR spaces are common in the elderly and are attributed to due to atrophy, so it would make sense that they could be seen in MS as well.

I am looking forward to the answer.

Quix