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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report III SESSIONE
“LE CRONICITÀ COMPLESSE”

Superficial siderosis
in long-standing pilocytic astrocytoma

F. SAVOLDI, L. CHIAPPARINI, A. ERBETTA

*Department of Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy

INTRODUCTION CASE REPORT

Pilocytic Astrocytoma (PA) is the most common pe- A 48-year-old woman with a past medical history of
diatric tumor of the central nervous system with a mild arterial hypertension properly treated presented
peak age of incidence of 5-15 years old. at our department for a second opinion complaining
PA is slow growing tumor and has an overall good of slow onset hearing loss since one year. Clinical ex-
prognosis, with survival rates at 10 years of more amination revealed dysarthria, positive Romberg test
than 90% . and severe optic neuropathy. Figure 1 and Figure 2
(1)
PA is most commonly located in the posterior fossa show brain and spine MRI respectively. SS involving
and along the optic nerves. Other localizations or an diffusely the spine and the infratentorial compartment
adult age of presentation are possible but less com- was evident with initial extension also along the
mon. Dissemination is a rare complication that can Silvian fissures. Diffuse leptomeningeal enhance-
involve the entire neuraxis . ment was demonstrated in the intracranial compart-
(2)
Intra-tumoral bleeding is a possible complication of ment and along the spine, in part linear and in part
higher-grade tumors due to areas of necrosis and with areas of pseudonodular and frank nodular en-
aberrant neovascularization, but has also been de- hancement. Diffuse areas of dural and bone remodel-
scribed in 8% of pilocytic astrocytomas . It has been ing were present in the skull base, mainly at the level
(3)
also reported that intratumoral hemorrhage in PA is of the Meckel caves, as well as at the emergence of
more common in adult patients . nerve roots along the spine. An angio-CT of the spine
(4)
Superficial Siderosis (SS) is a pathological condition excluded potential vascular malformations account-
characterized by protracted and slow bleeding in the ing for the chronic bleeding and SS.
subarachnoid space: while most cases of infratentori- CSF was xanthochromatic and its analysis showed
3
al SS are idiopathic, tumors can represent a possible numerous red blood cells (90,000 RBC/mm ) and in-
(5)
cause . creased proteins (1,176 mg/dL) and LDH (108 U/L).
We present a case of disseminated PA with associated Histological examination of a nodule in the dorsal
SS and dural remodeling. spine evidenced a grade I PA (GFAP and Olig 2+,
EMA-, MIB-1 proliferation index 1%).

Corrispondenza: Dr. Filippo Savoldi, Dipartimento di Neuroradiologia, Istituto Neurologico C. Besta, via Celoria 11, 20133 Milano
(MI), e-mail: filippo.savoldi@unimi.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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