Significance of Virchow-Robin Spaces in Patients Newly Diagnosed with Multiple Sclerosis: A Case-Control Study in an Arab Population

Objective: To assess the frequency and extent of dilatation of Virchow-Robin (VR) spaces at three levels of the brain in patients of Arab ethnicity in Kuwait recently diagnosed with multiple sclerosis (MS) and compare the results with age- and gender-matched controls. Methods: The magnetic resonance imaging (MRI) scans performed within 3 months of the clinical diagnosis of 80 patients recently diagnosed with active MS were compared to those of 80 age- and gender-matched controls with headache but without any neurological deficits for the frequency and size of VR spaces. MRI was done with noncontrast axial and coronal T1W FSE, axial T2W FSE, axial T2W FLAIR and sagittal FLAIR sequences followed by postcontrast axial and coronal T1W sequences. The frequency of VR spaces in MS patients and controls at midbrain, lenticulostriate vessels and supraventricular levels was analyzed using a two-tailed McNemar test. Results: There was no difference in the frequency of VR spaces at the levels of the midbrain, lenticulostriate vessels and supraventricular white matter between MS patients and controls. In the supraventricular region, however, there were 91 dilated VR spaces in 26 (32%) of the MS patients while in the control group, there were 8 dilated VR spaces in 6 (7.5%) patients and the difference was statistically significant (p 0.0001). Conclusion: The data showed that dilated VR spaces in the supraventricular region could potentially be used as a marker for MS and as a prognostic tool. However, further studies with a larger population are needed to further evaluate and confirm this observation.