Can Isolated Enlarged Virchow-Robin Spaces Influence the Clinical Manifestations of Parkinson's Disease?

Dilated Virchow-Robin (VR) spaces are usually not considered to be symptomatic. We present three cases presenting with atypical clinical features, which otherwise had clinical/imaging findings consistent with idiopathic Parkinson's disease. In all cases, an isolated large VR space in the basal ganglia contralateral to the side of symptom onset was observed. We propose that the atypical features could be associated with the mass effect of a significantly enlarged VR space, which would cause a dysfunction downstream from the presynaptic nigrostriatal dopaminergic system.