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A 53-year-old man with hypertension presented with a generalized tonic-clonic seizure. General and neurologic examination, serology, and ECG were normal. Brain MRI revealed asymmetrical tumefactive perivascular spaces (PVSs) with a right frontal mass effect (Figure). PVSs are pial-lined, interstitial fluid–filled structures that may be detected incidentally.1 Giant PVSs are rare, and imaging appearances can be dramatic. PVSs are more common in people with hypertension.1 PVSs are more asymmetrically clustered in those with focal epilepsy than controls,2 suggesting a possible role in pathogenesis. In this case, EEG showed slow and sharp waves in the right frontotemporal lobes, suggesting possible PVS-related seizure susceptibility.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and editor reviewed. The handling editor was Editor-in-Chief José G. Merino, MD, MPhil, FAHA, FAAN.
- Received February 24, 2022.
- Accepted in final form June 8, 2022.
- © 2022 American Academy of Neurology
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