Correlation between enlarged perivascular space and cerebral venous reflux in recent small subcortical infarcts within the lenticulostriate artery territory / 中华神经科杂志

Objective:To summarize the incidence of cerebral venous reflux (CVR) in patients with recent small subcortical infarct (RSSI) and explore its correlation with enlarged perivascular spaces (EPVS).Methods:Patients with RSSI in the lenticulostriate artery admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 were included. The baseline demographic data, medical history, and laboratory results of the patients were collected. CVR was assessed by time-of-flight magnetic resonance angiography. Patients were stratified into 2 groups based on the presence (CVR group) or absence of CVR (non-CVR group), and baseline characteristics as well as laboratory test results were compared between the 2 groups. The location and number of EPVS were evaluated using a visual grading scale, with EPVS with higher scores defined as high-grade EPVS (HEPVS). Simultaneous evaluation of cerebral white matter hyperintensities and lacunar infarctions was conducted, followed by intergroup comparisons. The relationship between EPVS and CVR was studied using multiple Logistic regression analysis.Results:A total of 571 patients with RSSI in the lentiform artery area were ultimately included, including 180 females (31.5%). Their age was (59.37±12.87) years. Among them, 73 patients (12.8%) exhibited CVR based on imaging findings, so the incidence of CVR was 12.8%. In comparison between the CVR group ( n=73) and the non-CVR group ( n=498), the proportion of females [21.9% (16/73) vs 32.9% (164/498), χ 2=3.578, P=0.059] was lower and the proportion of history of smoking [38.4% (28/73) vs 27.7% (138/498), χ 2=3.499, P=0.061] was higher in the CVR group, but without statistical significance. Additionally, the history of alcohol consumption [34.2% (25/73) vs 21.7% (108/498), χ 2=5.621, P=0.018] and the proportion of patients with concomitant HEPVS in the basal ganglia area [41.1% (30/73) vs 25.3% (126/498), χ 2=7.999, P=0.005] was higher in the CVR group with statistical significance. Multiple Logistic regression analysis showed that HEPVS in the basal ganglia region remained independently associated with CVR ( OR=1.988, 95% CI 1.190-3.320, P=0.009). Conclusion:EPVS in the basal ganglia region is significantly associated with CVR in the RSSI population, suggesting that venous dysfunction may be closely related to the formation of EPVS.

Updated Understanding of the Glial-Vascular Unit in Central Nervous System Disorders / 神经科学通报·英文版

The concept of the glial-vascular unit (GVU) was raised recently to emphasize the close associations between brain cells and cerebral vessels, and their coordinated reactions to diverse neurological insults from a "glio-centric" view. GVU is a multicellular structure composed of glial cells, perivascular cells, and perivascular space. Each component is closely linked, collectively forming the GVU. The central roles of glial and perivascular cells and their multi-level interconnections in the GVU under normal conditions and in central nervous system (CNS) disorders have not been elucidated in detail. Here, we comprehensively review the intensive interactions between glial cells and perivascular cells in the niche of perivascular space, which take part in the modulation of cerebral blood flow and angiogenesis, formation of the blood-brain barrier, and clearance of neurotoxic wastes. Next, we discuss dysfunctions of the GVU in various neurological diseases, including ischemic stroke, spinal cord injury, Alzheimer's disease, and major depression disorder. In addition, we highlight the possible therapies targeting the GVU, which may have potential clinical applications.

Research progress in the evaluation of glymphatic system function by the DTI-ALPS method / 中南大学学报(医学版)

The glymphatic system can remove metabolic wastes from the brain, which plays a significant role in maintaining the homeostasis of the central nervous system. It is an important basis for advanced cognitive functions such as learning and memory. Studies have analyzed the function of glymphatic system by diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) recently. Compared with other invasive examinations that require fluorescent tracer technique or the injection of contrast agents, DTI-ALPS can evaluate the hydromechanics of the glymphatic system via quantifying the diffusion rate of water molecules in different directions, which turns out to be a non-invasive in vivo neuroimaging method. The ALPS-index calculated by the DTI-ALPS method is significantly correlated with the cognitive function in diseases of central nervous system and other system and can reflect the dynamic changes of diseases. In general, ALPS-index is expected to become a novel neuroimaging biomarker for predicting prognosis and clinical effects.

Recent advance in neutrophil extracellular traps in ischemic stroke / 中华神经医学杂志

Neutrophil extracellular traps (NETs) are compounds composed of depolymerized DNA fibers and antimicrobial peptides released by neutrophils. NETs formation not only plays a role in pathological process of non-infectious diseases such as cystic fibrosis, systemic lupus erythematosus, diabetes and cancer, but also is closely related to many central nervous system diseases. In recent years, a large number of studies have found the presence of neutrophils and NETs in perivascular space of the infarcted lesions in patients with ischemic stroke (IS) and corresponding animal models. This article provides a review on NETs formation and clearance process, characteristics of NETs changes after IS, pathological processes involved in NETs after IS, and effects of NETs on neurons, to provide some references for IS.

Dysfunction of lymphatic system and early Parkinson′s disease / 中华神经科杂志

Lymphatic system is the transportation way of cerebrospinal fluid and brain interstitial fluid exchange. And this system is a central nervous drainage system which plays an important role in drainaging and discharging of metabolic waste in the brain. The function of this system can be evaluated indirectly by the perivascular space on magnetic resonance imaging. Parkinson′s disease is a common neurodegenerative disorder. It may be helpful to control the progression of the disease if the changes of perivascular space can be dynamically observed in the early or even prodromal stage of the disease. This article reviews the relationship between lymphatic system disfunction and early stage of Parkinson′s disease.

Glymphatic system in Parkinson′s disease / 中华神经科杂志

Parkinson′s disease is a degenerative disease of the central nervous system with abnormal protein deposition in the brain as the main pathological changes. The onset of Parkinson′s disease is related to abnormal deposition protein removal disorders, and the relevant mechanisms are still unclear. The glymphatic system is a metabolic waste and abnormal protein deposition removal system in the brain. In recent years, studies have shown that the changes of aquaporin 4, perivascular space and dural lymphatic vessels in Parkinson′s disease are closely related to the level of relevant pathological proteins in cerebrospinal fluid, leading to the occurrence and development of Parkinson′s disease. The researches on structure and biomarkers of the glymphatic system in Parkinson′s disease in recent years are reviewed in this article.

Relationship between perivascular space enlargement and cognitive and motor longitudinal changes in patients with Parkinson′s disease / 中华神经科杂志

Objective:To investigate the correlation between basal ganglia (BG) enlarged perivascular space (EPVS; BG-EPVS) and cognitive and motor longitudinal changes in patients with newly diagnosed Parkinson′s disease and its different motor subtypes [tremor dominant (TD), postural instability and gait disorder (PIGD)].Methods:A total of 131 Parkinson′s disease patients from the Parkinson Progression Markers Initiative (PPMI) database were screened and their clinical data were collected at baseline, 1 year and 2 years of follow-up. The number of EPVS in different brain regions was assessed on axial T 2-weighted images by cranial imaging data, and they were divided into two groups according to the degree of EPVS: BG-EPVS- and BG-EPVS+. Parkinson′s disease patients were divided into TD and PIGD groups by Movement Disorder Society Unified Parkinson′s Disease Rating Scale (MDS-UPDRS) score, and the number and clinical data of EPVS were compared between the two groups, and the correlation between the number and degree of BG-EPVS at baseline and longitudinal changes in clinical outcome measures of Parkinson′s disease and its different motor subtypes (TD, PIGD) was analyzed. Results:BG-EPVS was positively correlated with age ( r=0.32, P<0.01), Hoehn & Yahr stage ( r=0.21, P<0.05), serum neurofilament light chain ( r=0.18, P<0.05) and Epworth Sleepiness Scale score ( r=0.20, P<0.05) in all Parkinson′s disease patients. At baseline and 2 years, the number of BG-EPVS was more in the PIGD group than in the TD group (11.0±4.2 vs 9.0±3.8, t=2.18, P=0.03; 16.3±6.7 vs 12.6±4.6 , t=2.71 , P=0.007;after correction).At baseline, more BG-EPVS in patients with Parkinson′s disease and its motor subtypes (TD, PIGD) was significantly associated with baseline motor outcomes ( β=0.66, P=0.01; β=0.64, P=0.008; β=0.91, P=0.009), but not with cognitive outcomes. By linear mixed effects model analysis, BG-EPVS numbers and moderate to severe BG-EPVS were positively correlated with motor outcomes over time in patients with Parkinson′s disease and its motor subtypes (TD, PIGD) ( β=0.51, P=0.008; β=0.59, P=0.025; β=0.80, P=0.038). After dividing BG-EPVS in Parkinson′s disease patients into different degrees, moderate to severe BG-EPVS was positively correlated with motor outcomes over time ( β=3.30, P=0.031). Conclusion:In this longitudinal study, bigger baseline BG-EPVS numbers were found to be positively associated with longitudinal changes in dyskinesia severity in Parkinson′s disease patients, not with cognitive changes, and be able to predict decline in motor function over a 2-year follow-up period.

Correlation of enlarged perivascular spaces with post-stroke cognitive impairment in patients with acute mild stroke / 中华神经医学杂志

Objective:To investigate the relations between enlarged perivascular spaces (EPVS) and cognitive impairment in patients with acute mild ischemic stroke.Methods:A total of 234 patients with acute mild ischemic stroke admitted to our hospital from October 2019 to June 2021 were chosen in our study. According to the Montreal Cognitive Assessment (MoCA) scores 7 d after admission, these patients were divided into normal cognitive function group (MoCA scores≥26) and cognitive impairment group (MoCA scores<26). The clinical data and imaging data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was used to determine the independent influencing factors for post-stroke cognitive impairment (PSCI). Spearman correlation analysis was performed to analyze the correlations of severity degrees of EPVS of basal ganglia with MoCA total scores and each cognitive domain scores in patients from cognitive impairment group.Results:Among the 234 patients, 73 (31.2%) had normal cognitive function and 161 (68.8%) had cognitive impairment. As compared with normal cognitive function group, patients from cognitive impairment group had significantly older age, significantly less years of education, statistically higher fasting blood glucose level, significantly higher proportion of patients with moderate and severe basal ganglia EPVS, and significantly higher proportion of patients with white matter lesion (WML) grading 2 and 3 ( P<0.05). Multivariate Logistic regression analysis showed that age, years of education, basal ganglia EPVS and WML grading were independent influencing factors for PSCI ( OR=1.049, 95%CI: 1.007-1.093, P=0.021; OR=0.910, 95%CI: 0.832-0.995, P=0.039; OR=0.760, 95%CI: 1.176-2.637, P=0.006; OR=2.270, 95%CI: 1.219-4.228, P=0.010). Correlation analysis showed that the severity degrees of basal ganglia EPVS were negatively correlated with MoCA scores, and scores of visual space and executive ability scale, attention scale, language scale and delayed recall scale ( P<0.05). Conclusion:Acute mild ischemic stroke patients with older age, less years of education, severer basal ganglia EPVS and higher WML grading trends to have cognitive impairment; basal ganglia EPVS mainly affects the cognitive domains of visual space and executive ability, attention, language, and delayed recall.

Correlation between basal ganglia-enlarged perivascular space and executive function in patients with recent small subcortical infarct / 中华神经医学杂志

Objective:To identify the influencing factors for cognitive impairment in patients with recent small subcortical infarct (RSSI), and explore the relationship between enlarged perivascular space (EPVS) and executive function in patients with RSSI.Methods:From February to December 2021, 115 patients with RSSI accepted treatment in Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University were enrolled. According to Montreal cognitive assessment (MoCA) scores, these patients were divided into normal cognitive function group (MoCA scores≥26, n=45) and cognitive impairment group (MoCA scores<26, n=70); univariate analysis was used to analyze the differences of general clinical data and EPVS volume between the two groups; multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment. Patients were further divided into EPVS non-mild group and EPVS moderate-severe group according to EPVS visual assessment; the differences of scores of different executive function domains were compared between the two groups; Spearman correlation analysis was used to observe the relationships of EPVS grading and volume with executive function. Results:Patients in the cognitive impairment group had significantly older age, significantly higher serum creatinine level, proportion of patients with moderate-severe basal ganglia EPVS (BG-EPVS) and BG-EPVS volume, and significantly lower years of education as compared with those in the normal cognitive function group ( P<0.05). Multivariate Logistic regression analysis showed that BG-EPVS volume ( OR=1.421, 95%CI: 1.028-1.965, P=0.034) was an independent risk factor for RSSI combined with cognitive impairment. MoCA total scores, scores of visual space and executive function domains in patients of the BG-EPVS moderate-severe group were significantly lower than those in patients of the BG-EPVS non-mild group, while Z-scores of Stroop color word test (SCWT) and trail making test (TMT), and total Z-scores of executive function were significantly higher than those in patients of the BG-EPVS non-mild group ( P<0.05). Spearman correlation analysis showed that BG-EPVS grading and volume were positively correlated with total Z-scores of executive function in RSSI patients with cognitive impairment ( r=0.439, P=0.001; r=0.410, P=0.001). Conclusion:BG-EPVS volume is an independent risk factor for cognitive impairment, and both BG-EPVS grading and volume are correlated with impairment degrees of executive function in cognitive function in RSSI patients.

Discussion on Connotation of "Essence Generating Marrow " Based on Intervention of Guilu Erxian Gum in Perivascular Space of Alzheimer's Disease Patients / 中国实验方剂学杂志

Objective:To study the effect mechanism of Guilu Erxian gum on Alzheimer's disease （AD） from the perspective of regulating perivascular space （PVS），and to explore the scientific connotation of "essence generating marrow". Method:The 80 patients with AD diagnosed by western medicine and kidney deficiency and marrow empty syndrome diagnosed by traditional Chinese medicine were randomly divided into two groups，with 40 cases in each group. Both groups of patients were orally administered with cholinesterase inhibitor Alison，one tablet （5 mg） each time before sleep at night. On this basis，the control group additionally received placebo，while the treatment group was additionally treated with Guilu Erxian gum for 60 days. The Mini-Mental State Examination scale （MMSE）， Wechsler Memory Scale and Activity of Daily Living Scale （ADL） were used before treatment （0 d），as well as 31 d and 61 d after treatment. The number and diameter of PVS in midbrain，basal ganglia，deep insular white matter and semiovale center were counted and their diameters were measured with use of nuclear magnetic resonance imaging （MRI） for head. In addition，the curative effect was evaluated according to MMSE scores on 61 d. Result:There was no significant difference between the two groups 31 d. On 61 d，MMSE and WMS scores increased，while ADL scores decreased as compared with the conditions on 0 d（<italic>P</italic><0.01），and there were significant differences in the three indexes and clinical effective rate between two groups （<italic>P</italic><0.05，<italic>P</italic><0.01） . In addition，there was no significant difference in the number of PVS as compared with the number before treatment and in the comparison between the two groups after treatment，but there was a significant difference in the diameter of PVS（<italic>P</italic><0.01）. Conclusion:Guilu Erxian gum is effective in the treatment of AD，and it can improve the PVS diameter in patients，which may be related to the mechanism of "essence generating marrow ".

The relationship between migraine and pericerebral vascular space / 中风与神经疾病杂志

@#Objective To investigate the relationship between migraine and enlarged perivascular spaces.Methods The databases including PubMed，Embase，Cochrane Library，CNKI and Wanfang were searched by computer，and the published data from January 2000 to May 2020 were collected case control study and cohort study on migraine and perivascular space. According to the inclusion and exclusion criteria，the literature was selected，and the data were extracted and the quality of the literature was evaluated. The RevMan5.3 software was used for meta analysis. Results Three articles in Chinese and two articles in English were included，and the 95%CI was 2.01［1.12，3.61］（P=0.02），that is the probability of enlarged perivascular spaces in migraine patients was 2.01 times that in the control group.Conclusion Patients with migraine are more likely to have enlarged perivascular spaces.

Atypical Virchow-Robin SpacesMimicking Cystic Primary Brain Tumor ­ Clinical Report and Literature Review

The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT andMRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mimicking brain tumors that required imaging follow-up or even a biopsy to confirm the diagnosis or to indicate the correct approach. Although it is not so unusual, one of them occurred concomitantly and adjacent to a diffuse glioma (co-deleted 1p19q, WHO-GII).

Relation between total burden of cerebral small vessel disease and post stroke depression / 中华神经医学杂志

The total burden of cerebral small vessel disease (CSVD) is recently proposed to estimate the full impact of CSVD on the brain, and the evaluated method is to calculate the scores of MR imaging features of four kinds of CSVD, which includes white matter hypertensity, cerebral microbleeds, lacune and enlarged perivascular space. Patients with post stroke depression (PSD) often have different imaging features of CSVD. Recent research shows that the total burden of CSVD is closely related to PSD. This article reviews the relation between total burden of CSVD and PSD.

Study on the factors influencing the changes of perivascular space after glioma surgery / 局解手术学杂志

Objective To investigate the risk factors of perivascular space change after brain tumor surgery.Methods According to the occurrence of postoperative perivascular space change,80 cases of glioma patients were divided into perivascular space and reconstruction group(observation group,n=38)and normal postoperative perivascular space group(control group,n=42).Compared the general data,sur-gery,tumor related indicators and postoperative complications of the two groups,and analyzed the influencing factors of the perivascular space changes after brain tumor surgery.Results In the observation group,the operation time of the patients was(95.38 ±9.21)min,which was significantly longer than(75.36 ±9.05)min in the control group.The intraoperative blood loss was(290.32 ±45.47)mL in the observation group,which was significantly more than(247.19 ±36.75)mL in the control group,and the difference was statistically significant (P<0.05).The tumor site located in the left hemisphere,tumor volume more than 40.0 cm3,high grade glioma,and proportion of patients with postoperative complications in the observation group were all higher than those of the control group,and the difference between the two groups was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that age,tumor location,tumor volume,patho-logical grade and complications were significantly correlated with the changes of perivascular space after surgery(P<0.05).Conclusion Advanced age,tumor located in the left side of the brain,large tumor volume,severe pathology,postoperative epilepsy,chronic intracranial hy-pertension and other complications were the risk factors affecting the changes of perivascular space in patients with glioma.

Magnetic resonance imaging characteristics of perivascular space in migraine / 中华神经科杂志

Objective To analyze the distribution of Virchow-Robin spaces (VRS) in migraine by MRI,and to study the effects of the duration of the disease,the attack frequency and the migraine with or without aura on the number of VRS in order to provide imaging support for migraine diagnosis.Methods Fifty migraine patients were enrolled as migraine group and 50 healthy people as control group during January 2013 to December 2016 from Department of Neurology,the Second Affiliated Hospital of Zhengzhou University.The number of VRS in the fronto-parietal subcortical white matter,semioval central,and basal ganglia areas was calculated and compared between groups and within the group by performing a MRI scan of the same sequence,and the impact of the history of migraine,the attack frequency and the migraine with or without aura on the number of VRS was investigated.Results The VRS were found in 48 cases in the migraine group,accounting for 96％,significantly higher than in the control group (41 cases,accounting for 82％),the difference being statistically significant (x2 =5.00,P ＜ 0.05).In the migraine group,the sum of the number of VRS (13.00 (6.75,20.00)) was significantly higher than that of the control group (8.00 (5.00,12.00);Z=3.33,P＜ 0.01).In the migraine group the VRS numbers in the fronto-parietal subcortical white matter,semioval central and basal ganglia areas were 6.00(4.00,12.00),2.00(0.00,4.00)and 4.00 (2.00,6.00) respectively,while the numbers of VRS in the same areas of the control group were 0.00 (0.00,2.00),2.00 (0.75,4.00) and 4.00 (3.50,6.00).The total number of VRS in different areas was significantly different within the two groups (migraine group x2 =39.86,P ＜ 0.01;control group x2 =40.15,P ＜0.01).In the migraine group,the VRS was mainly located in fronto-parietal subcortical white matter,whereas in the control group the VRS was mainly distributed in the basal ganglia.The total number of VRS in the migraine with aura group (20.00 (14.50,26.00)) was more than that in the migraine without aura group (11.00 (6.00,20.00);Z =2.52,P =0.02).The numbers of VRS in the fronto-parietal subcortical white matter,semioval central and basal ganglia areas of the migraine with aura group were 12.00(9.00,14.00),2.00(2.00,6.00) and 4.00(2.50,7.50) respectively;The numbers of VRS in the same areas of the migraine without aura group were 6.00(4.00,10.00),1.00(0.00,4.00) and 4.00 (2.00,6.00) respectively;The numbers of VRS in different areas within the two groups were significantly different (with aura group x2 =16.31,P ＜0.01;without aura group x2 =29.48,P ＜0.01).There were statistically significant differences in the number of VRS among migraine without aura patients with different duration and frequency of episodes.Conclusions The incidence rate of perivascular space in migraine is high.VRS is mainly distributed in the fronto-parietal subcortical white matter,which may provide an imaging assistant basis for the diagnosis of migraine.Migraine with aura is more prone to VRS than those without aura.The disease course and the attack frequency have a certain impact on occurrence of VRS.

Influence of perivascular space enlargement on the prognosis of acute anterior circulation mild stroke / 医学研究生学报

Objective Few studies are reported on the influence of perivascular space enlargement (PVSE) on the prognosis of cerebral infarction. This study was to investigate the clinical correlation of EPVS in the basal ganglia and central semiovale with the prognosis of the first acute cerebral infarction (ACI) with anterior circulation mild small-artery occlusion (SAO).Methods We treated 137 cases of the first ACI with anterior circulation mild SAO in Tangshan Gongren Hospital from August 2015 to October 2016. According to the scores on PVSE in the basal ganglia and central semiovale, we divided the patients into a mild PVSE (score: 0-1) and a severe PVSE group (score: 2-4). Based on the National Institutes of Health Stroke Scale (NHISS) and the modified Rankin Scale (MRS) scores, we classified the outcome of neurological function recovery as good (MRS≥2) and poor (MRS<2) and analyzed the risk factors for the poor prognosis of ACI by logistic regression analysis.Results There were 60 cases of severe and 77 cases of mild PVSE in the in the basal ganglia as compared with 57 cases of severe and 80 cases of mild PVSE in the in the central semiovale. Good prognosis was achieved in 97 cases while poor prognosis observed in 40. Multivariate logistic regression analysis showed that the risk factors for the poor prognosis of ACI included NHISS at the onset (OR=5.393, 95% CI: 1.858-15.654), hypertension (OR=3.729, 95% CI: 1.310-10.610), and the severity of PVSE in the basal ganglia (OR=3.137, 95% CI: 1.343-7.325).Conclusion For the first acute cerebral infarction with anterior circulation mild small-artery occlusion, the severity of PVSE in the basal ganglia is an important factor affecting the recovery of neurological function.

Recent advances in central nervous system lymphatic circulation / 中华神经医学杂志

Lymphatic system has important functions such as immune defense and maintaining the stability of internal environment.Traditional anatomy of the central nervous system thought that there are no lymphatic vessels lined with endothelial cells in the central nervous system or lymph circulation.But the latest research shows that there is lymph circulation in the brain,and the meningeal lymphatic vessels are found.To further elucidate the structure and function of the lymph circulation in the central nervous system,we review the latest research progress of composition,drainage and physiological functions of the central nervous system and how it plays a role in the immune related diseases of the central nervous system.

A Case of Disseminated Polycystic Dilated Perivascular Spaces Presenting with Dementia and Parkinsonism

The perivascular spaces (PVSs) of the brain are lined with pia and contain interstitial fluid. In general, PVSs are small, asymptomatic, and identifiable at all ages. When PVSs are significantly enlarged, they can produce various clinical manifestations such as headache and dizziness. A 67-year-old man was admitted with cognitive impairment and gait disturbance with a 5-month history. Brain MRI showed multiple cystic PVSs in periventricular and subcortical white matter of both hemispheres. Medication with dopaminergic agents produced a moderate clinical improvement, while anticholinesterase was not effective. This case suggests that disseminated polycystic dilated PVSs may present with dementia and Parkinsonism.