• World Neurosurg · Nov 2023

    Case Reports

    Giant tumefactive perivascular spaces: an unusual cause of Holmes Tremor.

    • Avinash Lakha and Sumit Thakar.
    • Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
    • World Neurosurg. 2023 Nov 1; 179: 666766-67.

    AbstractA 34-year-old man presented with a 2-year history of medically refractory Holmes tremor in the right upper limb. Magnetic resonance imaging revealed a large, nonenhancing, multiseptate cystic lesion of cerebrospinal fluid intensity in the left thalamopeduncular region causing brainstem compression and hydrocephalus. A diagnosis of giant tumefactive perivascular spaces was made after a biopsy ruled out an infectious or neoplastic etiology. Significant clinicoradiologic improvement was noted following a ventriculoperitoneal shunt. Giant tumefactive perivascular spaces should be included as one of the rare differentials of a large, nonenhancing cystic lesion situated along the course of perforator vessels. Treatment options include cerebrospinal fluid diversion with or without cyst fenestration.Copyright © 2023 Elsevier Inc. All rights reserved.

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