The role of perivascular Virchow-Robin spaces was investigated in 45 multiple sclerosis (MS) patients and 30 healthy controls, in a study at Charite-Universitaetsmedizin Berlin, and Goethe University, Frankfurt. Virchow-Robin spaces (VRS) that surround small blood vessels as they penetrate brain parenchyma were identified in the same number of MS patients as healthy controls. However, the VRS were significantly larger in volume in MS (p=0.004). This difference was not explained by brain atrophy but at follow-up, a significant increase in VRS volume was correlated with contrast-enhancing lesions, indicative of inflammation. VRS volume increase may be supportive of inflammatory demyelination in the brain. 
COMMENT. The authors interpret the prominence of Virschow-Robin spaces in the brain of MS patients as a sign of inflammation, not of age, and VRS are recognized for their potential as modulators of immune responses.
The prevalence and clinical significance of dilated VRS in childhood was investigated by MRI in 1,250 patients, during 12 consecutive months at Children’s Medical Center, Dallas, TX . Of 37 patients with prominent VRS, 12 had severe headache, 17 had moderate or severe delay in development, and 18 had serious behavioral or psychiatric problems. The association of these symptoms and dilated VRS was significant (p<0.001).
In a retrospective review of 816 MR scans, 314 had large VRS in a study at New York Hospital, NY . Of patient variables studied statistically, that included age, gender, incidental white matter lesions, infarction, dementia, hypertension, and atrophy, only age was significantly correlated with large VRS.
Kwee RM et al in the Netherlands review the significance of dilated VRS . The three characteristic locations for dilated VRS are lenticulostriate arteries, perforating medullary arteries, and the midbrain. Occasionally, VR spaces become very large and even cause mass effect. The signal intensity is identical to that of CSF. They should be differentiated from lacunar infarctions, periventricular leukomalacia, multiple sclerosis, arachnoid cysts, cystic neoplasms, and neurocysticercosis.