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Giant Tumefactive Perivascular Spaces in a Patient Presenting With a First Seizure


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.



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