From the Guidelines
Large basal ganglia perivascular spaces are generally considered a benign finding on brain imaging, but may be associated with conditions like hypertension, cerebral small vessel disease, or inflammatory processes, as suggested by a study published in Alzheimer's and Dementia 1. These spaces, also called Virchow-Robin spaces, become more prominent with age and are a normal part of the brain's anatomy. When described as "large," it typically means these spaces are more visible than usual on MRI or CT scans. Some key points to consider about large basal ganglia perivascular spaces include:
- They are usually harmless and require no treatment
- They may be associated with vascular risk factors, such as arterial hypertension, and other markers of small-vessel disease, as reported in a large prospective population-based study 1
- They function as part of the brain's waste clearance system (glymphatic system), allowing cerebrospinal fluid to circulate around blood vessels and remove metabolic waste products
- If you've received a radiology report mentioning large basal ganglia perivascular spaces, it's generally not a cause for concern unless accompanied by neurological symptoms or other abnormal findings
- Your doctor may recommend routine follow-up imaging if the spaces are particularly prominent, but intervention is rarely needed for this common incidental finding. In terms of specific conditions, a study found that microhemorrhages (mHs) in deep locations, such as the basal ganglia, were associated with arterial hypertension, white matter hyperintensities, and lacunar infarcts 1. However, the etiology of mHs may differ according to location, with deep mHs caused by hypertensive vasculopathy and lobar mHs caused by cerebral amyloid angiopathy (CAA) 1. Overall, while large basal ganglia perivascular spaces are generally not a cause for concern, it's essential to consider the individual's overall clinical context and any accompanying symptoms or findings.
From the Research
Large Basal Ganglia Perivascular Space
The presence of large basal ganglia perivascular spaces (PVS) has been associated with cerebral small vessel disease (CSVD) in several studies 2, 3, 4, 5, 6.
- Association with CSVD: PVS are thought to be a marker of CSVD, which can lead to adverse neurological outcomes 2.
- Relationship to other CSVD manifestations: Studies have shown that PVS in the basal ganglia are related to other CSVD manifestations, such as white matter hyperintensities (WMH), cerebral microbleeds (CMB), and lacunar infarcts 2, 5.
- Cognitive impairment: While some studies have found no significant association between PVS and cognitive impairment 5, others have suggested that dilated PVS in the basal ganglia may be a biomarker of small-vessel disease in elderly populations with dementia 4.
- Deep medullary veins changes: Recent research has suggested that changes in deep medullary veins (DMVs) may be involved in the pathogenesis of PVS in the basal ganglia 6.
- Risk factors: Hypertension and age have been identified as risk factors for PVS in the basal ganglia 2, 5, 6.
Clinical Significance
The clinical significance of large basal ganglia PVS is still being researched, but studies suggest that they may be a valuable biomarker of small-vessel disease in various populations 3, 4, 6.
- Biomarker of small-vessel disease: PVS in the basal ganglia have been shown to be a specific biomarker of cerebral small-vessel disease in young patients with dementia 3 and in elderly populations with dementia 4.
- Discriminative power: One study found that PVS in the basal ganglia had independent significant discriminative power in distinguishing between dementia and healthy volunteers, as well as between vascular dementia and Alzheimer's disease 4.