From the Research
Prominent Virchow-Robin spaces (VRS) found incidentally on brain MRI in a patient with memory concerns are generally considered a normal variant and not clinically significant, as supported by the most recent study 1. No specific treatment or intervention is needed for these findings alone. VRS are perivascular spaces filled with cerebrospinal fluid that follow the course of blood vessels as they penetrate the brain parenchyma. While they can become more prominent with age, hypertension, or other vascular risk factors, their presence alone does not explain memory symptoms, as noted in previous studies 2, 3, 4, 5. The memory concerns should be evaluated independently through:
- Cognitive testing
- Comprehensive history-taking
- Assessment of other potential causes such as neurodegenerative diseases, vascular cognitive impairment, medication effects, or metabolic disorders. In some cases, very enlarged or unusually distributed VRS might warrant follow-up imaging to ensure stability, but this would be determined by the radiologist and treating physician, as suggested by the study 1. The patient should be reassured that prominent VRS are a common finding, even in healthy individuals, and attention should be directed toward identifying the true cause of memory symptoms rather than focusing on this incidental finding. It is essential to consider the clinical context and the appearance of the adjacent tissue on MRI to determine whether dilated VRS are a normal variant or part of a disease process, as discussed in the study 5. Overall, the current evidence suggests that prominent VRS are not a significant concern in patients with memory concerns, and further evaluation should focus on identifying the underlying cause of their symptoms.