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The patient��s Unified Parkinson��s Disease Rating Scale (UPDRS) total motor score was 15. There were no abnormalities on cerebellar function tests. Mini-Mental State Examination (MMSE) score was 27. Neuropsychological tests, however, Bioactive Compound Library manufacturer showed impairments (Chloramben ?andF).F). On follow-up examination 4 years after onset, there was worsening of parkinsonian motor deficits, particularly gait disturbances and postural instability, and further cognitive dysfunctions. His UPDRS total motor score was 27 and MMSE score was 20. Follow-up brain MRI studies showed no significant changes. Figure 1. T2-weighted brain magnetic resonance imaging studies show mixture of high signal intensity lesions and numerous round and septate cystic lesions in the (A) right high cerebral convexity and (B and C) temporal lobes. [18F]-deoxyglucose PET studies show ... DISCUSSION Giant Virchow-Robbin spaces in the high cerebral convexity are characterized by clustered sharp demarcated round, oval, or linear cystic lesions. On brain MRI studies, they did not enhance and are iso-intense with cerebrospinal fluid [2,3]. In approximately 80% of reported cases, GVRSs involved see more one cerebral hemisphere [1-5]. Giant Virchow-Robbin spaces in the high cerebral convexity are usually found incidentally [4,5] or during the evaluation for non-specific neurological symptoms (e.g., fainting, dizziness, hearing impairment [1], headache, or visual change [2]). Rarely, patients may present with dementia [2]. The patient reported herein developed progressive parkinsonism and dementia in association with GVRSs in the high cerebral convexity. MR tractography studies of patients with GVRSs showed markedly reduced fibers in the affected cerebral hemisphere [4] Therefore, GVRSs and white matter lesions in our patient may have disrupted cortical efferent fibers to the basal ganglia and afferent fibers to the motor-related cerebral cortices. The parkinsonism seen in our patient seemed to share a common pathogenic mechanism with the parkinsonism associated with Binswanger disease.