Extensive Perivascular Spaces in the Centrum Semiovale: A Diagnostic Pitfall

Enlarged Virchow–Robin spaces are benign perivascular fluid-filled structures that may occasionally mimic pathological intracranial lesions on imaging. We report a 55-year-old male who presented with intermittent dizziness and was found to have extensive cystic lesions involving the left cerebral hemisphere on magnetic resonance imaging. The lesions demonstrated signal characteristics identical to cerebrospinal fluid across all sequences, with no diffusion restriction, contrast enhancement, edema, or mass effect, and followed the distribution of medullary arteries within the centrum semiovale. These features were consistent with type II enlarged Virchow–Robin spaces. The patient had previously been advised surgical intervention elsewhere; however, recognition of the characteristic imaging appearance allowed avoidance of unnecessary biopsy. Awareness of this entity and its typical radiological features is essential to differentiate it from cystic neoplasms, infections, or infarcts, thereby preventing unwarranted invasive procedures.