Virchow-Robin space enlargement associated with borderline intelligence and behavioral problems in a young male

A 22-year-old male presented with borderline intelligence, visual and auditory hallucinations, and an obsessive urge to bite. He was investigated for organic pathology in view of visual hallucinations and his magnetic resonance imaging study showed enlarged Virchow-Robin Space, which are fluid-filled spaces that surround small blood vessels and capillaries in the brain. He had no facial dysmorphic features or autistic features. Literature reports that this finding is associated with dementias in elderly, obsessions, and auditory hallucinations, but there is little data on its association with visual hallucinations, or intellectual impairment in the young. He responded well to a combination of medications and psychosocial approaches. Neuroimaging offers a noninvasive, reproducible method to better understand the clinical associations and accumulate evidence base in young patients presenting with intellectual impairment and behavioral problems.