A 59-year-old, right-handed man presented with orbital apex syndrome, which resolved with corticosteroids. He was otherwise completely healthy. Incidentally, he had strikingly abnormal magnetic resonance imaging (MRI) results owing to giant widening of the Virchow-Robin spaces (Figure 1). To determine whether the abnormal-looking hemisphere was functioning normally, we performed magnetic resonance tractography and functional MRI (fMRI) studies with a high-field MRI scanner (Philips Achieva 3T; Koninklijke Philips Electronics NV, Eindhoven, the Netherlands). Magnetic resonance tractography by diffusion tensor imaging acquisition (32 directions; repetition time, 3995 milliseconds; echo time, 72 milliseconds; matrix, 128 × 128) with fiber tracking (FiberTrak Software; Philips Medical System Inc, Newnan, Georgia) showed that volume and density of fiber tracts in the left hemisphere were slightly reduced compared with those in the right hemisphere (Figure 1).
Wong SH, Das K, Puthuran M, Lecky B, White R. Giant Virchow-Robin Spaces: Functional Magnetic Resonance Imaging and Tractography. Arch Neurol. 2010;67(6):768-769. doi:10.1001/archneurol.2010.92