Superﬁcial Siderosis Related to a Thoracic Disc Herniation with Associated Dural Injury

CNS Neuroscience & Therapeutics, 2014 · DOI: 10.1111/cns.12253 · Published: April 1, 2014

Simple Explanation

Superficial siderosis (SS) is a condition where chronic bleeding into the subarachnoid space causes iron deposition in brain tissues, leading to neurological issues. This deposition shows up as hypointensity on T2-weighted MRI scans. It can be caused by prior surgeries, trauma, tumors or dural injuries. The case reported here describes superficial siderosis caused by a thoracic disc herniation, an unusual cause for this condition.

Study Duration

6 months

Participants

One 66-year-old male

Evidence Level

Case Report

Key Findings

1
The patient presented with leg weakness, gait impairment, hearing loss, and urinary incontinence.
2
MRI revealed hypointensity around the brainstem, cerebellar folia, cerebral fissures, and along the spinal cord's pial surface, along with a T8-T9 disc herniation.
3
Dynamic CT myelogram showed a ventral dural defect at the level of the thoracic disc herniation, confirming the source of bleeding.

Research Summary

This letter to the editor presents a case of superficial siderosis (SS) in a 66-year-old man, linked to a thoracic disc herniation and associated dural injury. The patient exhibited symptoms including leg weakness, gait impairment, hearing loss, and urinary incontinence. Imaging revealed hemosiderin deposits and a dural defect. Although surgical repair was offered, the patient declined, and remained stable after 6 months of follow-up. Dural injury due to disc herniation should be considered as a cause of SS.

Practical Implications

Diagnostic Awareness

Clinicians should consider dural injury from disc herniation as a potential cause of superficial siderosis, especially in patients with unexplained neurological symptoms.

Advanced Imaging

Employ advanced imaging techniques, such as dynamic CT myelography, to identify dural defects and sources of bleeding in suspected cases of superficial siderosis.

Tailored Therapy

Treatment should focus on identifying and addressing the underlying cause of the bleeding to prevent further progression of the condition.

Study Limitations

1
The study is limited to a single case report, which may not be generalizable to all patients with superficial siderosis.
2
The patient declined surgical repair, limiting the ability to assess the long-term impact of surgical intervention on the condition.
3
The follow-up period was relatively short (6 months), and longer-term outcomes are unknown.

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