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Proceedings SNO “Percorsi clinici in Neuroscienze”

netic on T2*. This phenomenon is protective against toma and leptomeningeal dissemination. Int J Radiat
the damage from iron related free radicals, but in the Oncol Biol Phys 2012; 84 (2): 350-354.
long term is dysfunctional and results in SS (9). 3. White JB, Piepgras DG, Scheithauer BW, Parisi JE. Rate
Moreover tissues lacking this protective mechanism, of spontaneous hemorrhage in histologically proven cas-
in particular cranial nerves, suffer earlier from free es of pilocytic astrocytoma. J Neurosurg 2008; 108 (2):
223-226.
radical related damage.
SS has been classified into cortical SS, mainly asso- 4. Shibao S, Kimura T, Sasaki H, Fujiwara H, Akiyama T,
ciated with amyloid angiopathy or post-traumatic, Ueno M, Shidoh S, Yoshida K. Hemorrhagic onset of
cerebellar pilocytic astrocytoma in an adult: a case report
(10)
and infratentorial SS . Most cases of infratentorial
and review of the literature implying a possible relation of
SS are idiopathic; according to a review of 270 cases degenerative vascular changes to the massive intratu-
of SS, 15% are represented by tumors with associat- moral hemorrhage. Brain Tumor Pathol 2012; 29 (2): 96-
ed bleeding events (11) and PA has been described in 102.
this group of pathologies, as in our case. Interestingly, 5. Kumar N. Neuroimaging in superficial siderosis: an in-
SS can also manifest as a sign of tumor recurrence in depth look. AJNR Am J Neuroradiol 2010; 31 (1): 5-14.
6% of cases (11,12) , but has also been described as a post- 6. Bostantjopoulou S, Katsarou Z, Pigadas A, Kazis A.
surgical sequela in the absence of tumor recurrence in Superficial CNS siderosis and spinal pilocytic astrocy-
7% of cases . Trauma, vascular malformations and toma. Neurology 2000; 55 (3): 450.
(11)
dural pathologies have been described as additional 7. Jetty SN, Badar Z, Drumsla D, Mangla R. Clinical signif-
potential causes (10,13) . In particular, it is worth noting icance of T2*gradient-recalled echo/susceptibility-
that dural tears have been recently described as a pos- weighted imaging sequences in evaluating superficial
sible cause of SS. Pseudomeningoceles or alterations siderosis in the setting of intracerebral tumors: Pilocytic
Astrocytoma. J Clin Imaging Sci 2018; 8: 36.
in the dural profile have indeed been described in
some reports and have been generally groups under 8. Bracchi M, Savoiardo M, Triulzi F, Daniele D, Grisoli M,
Bradac GB, Agostinis C, Pelucchetti D, Scotti G. Super-
(13)
the umbrella of “duropathies” . It is therefore possi-
ficial siderosis of the CNS: MR diagnosis and clinical
ble that the dural and nearby bone alterations seen in
findings. AJNR Am J Neuroradiol 1993; 14 (1): 227-236.
our patients might represent a manifestation of a sim-
9. Koeppen AH, Michael SC, Li D, Chen Z, Cusack MJ,
ilar process, contributing to the development of SS.
Gibson WM, Petrocine SV, Qian J. The pathology of su-
However, we cannot exclude they might be a sequela perficial siderosis of the central nervous system. Acta
of chronic bleeding rather than a cause, representing Neuropathol 2008; 116 (4): 371-382.
a consequence of an altered cerebrospinal fluid flow
10. Wilson D, Chatterjee F, Farmer SF, Rudge P, McCarron
or pressure. MO, Cowley P, Werring DJ. Infratentorial superficial
In conclusion, we report a case of disseminated PA siderosis: Classification, diagnostic criteria, and rational
with associated SS and remodeling of the dura. investigation pathway. Ann Neurol 2017; 81 (3): 333-343.
11. Levy M, Turtzo C, Llinas RH. Superficial siderosis: a
case report and review of the literature. Nat Clin Pract
Neurol 2007; 3 (1): 54-58.
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