![]() 29, 35, 36 The precise mechanism of bleeding in these cases is unknown. 2, 3, 28 – 31, 35, 36 A CT myelogram, dynamic CT myelogram, or digital substraction myelogram can identify a dural defect that connects the intrathecal space with the fluid-filled collection. In recent years, an extra-arachnoid longitudinally extensive intraspinal fluid-filled collection has been frequently noted in patients with SS. 25 In vivo MR imaging and postmortem correlation have shown that the hemosiderin deposition around the brain, brain stem, and spinal cord is the cause of the characteristic hypointensity seen on T2-weighted MR imaging. 32 – 34 With widespread use of MR imaging, presymptomatic cases are being diagnosed, and it is difficult to be certain about the true incidence of the disorder. 32 The diagnosis of SS had largely been postmortem or made during surgical exploration. 2, 3, 8, 19 – 31 Before the advent of MR imaging, approximately 40 cases had been reported in the world literature. 2, 8 – 18 Often decades elapse between the presumed inciting event and the development of symptoms attributable to SS.īrain MR imaging is the investigation of choice for the diagnosis of SS. A prior history of trauma (at times trivial) or intradural surgery (commonly involving the posterior fossa) may be present. Commonly performed investigations during the work-up of SS include MR imaging of the brain and spine, CT myelography, MR angiography, and cerebrospinal angiography. 1 – 3 The bleeding source may be not be detected despite extensive neuroimaging. The classic clinical presentation of SS includes adult-onset slowly progressive gait (less commonly appendicular) ataxia with cerebellar dysarthria and sensorineural hearing impairment. 4 – 7 Accelerated ferritin synthesis in the Bergmann glia of the cerebellum may account for preferential cerebellar involvement. The ability of the brain to biosynthesize ferritin in response to prolonged contact with hemoglobin iron is important in the pathogenesis of SS. 1 – 4 The hemosiderin deposition is a consequence of recurrent and persistent bleeding into the subarachnoid space. Superficial siderosis (SS) of the central nervous system (CNS) results from hemosiderin deposition in the subpial layers of the brain and spinal cord. This review discusses the role of multitechnique imaging in the work-up of patients with SS and focuses on recent developments. ![]() A similar finding has also been reported in patients with craniospinal hypotension. An intraspinal fluid-filled collection of variable dimensions is frequently seen on spine MR imaging in patients with idiopathic SS. Very rarely, serious complications may occur with a CSF leak, and emergency surgery is needed to sew together the dura.SUMMARY: Despite extensive imaging, a source of bleeding is often not evident during the evaluation of patients with superficial siderosis (SS) of the central nervous system. They may also prescribe antibiotics to address an infection. This is a blood clot used to seal the leak. If headache persists for more than a week, doctors may decide to patch the hole that is leaking the fluid with a blood patch. ginger candies or anti-nausea medications.oral and intravenous hydration and caffeine, given separately. ![]() ![]() Often times, doctors may advise the following conservative measures to address symptoms: Many of the symptoms resolve on their own within a few days, depending on the specific cause of the CSF leak. radioisotope test to track the CSF leakage.If doctors feel they need to confirm a CSF leak to rule out other conditions, they may run several tests. Many times, doctors prescribe treatment based on results from a physical exam and reported symptoms. ![]()
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