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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1511-1512

”Black Brain and Dark Nerve”—Think Hemosiderosis


Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka, India

Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Thomas Mathew
Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru – 560034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304114

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How to cite this article:
Mathew T, John S, Kumar S, Sekhar M. ”Black Brain and Dark Nerve”—Think Hemosiderosis. Neurol India 2020;68:1511-2

How to cite this URL:
Mathew T, John S, Kumar S, Sekhar M. ”Black Brain and Dark Nerve”—Think Hemosiderosis. Neurol India [serial online] 2020 [cited 2021 Jan 19];68:1511-2. Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1511/304114




A 67-year-old female presented with history of cognitive decline, deafness, and inability to walk for the past six months. On examination patient was drowsy but arousable, pupils were bilaterally equal and reactive, had spasticity in all limbs, with lower limbs more involved than upper limbs. Power was 4/5 in both upper limbs and 3/5 in lower limbs. Deep tendon reflexes were brisk with extensor plantar response on both sides. MRI brain showed black pigmentation of 8th nerve, cerebellar and cerebral cortex [Figure 1], [Figure 2], [Figure 3]. MRI of the whole spine was normal. Patient was evaluated in detail for the cause of recurrent bleeding including digital subtraction angiography of brain and spinal cord and extensive coagulation profile which were normal.
Figure 1: MRI brain T2* gradient recalled echo (GRE) sequence showing hyperpigmented (black color), hemosiderin stained 8th nerve complex on either side (white arrows)

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Figure 2: MRI brain T2* GRE sequence showing hyperpigmented (black color), hemosiderin stained cerebellar folia (white arrows)

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Figure 3: MRI brain T2* GRE sequence showing hyperpigmented (black color) hemosiderin stained cerebral sulci. (white arrows)

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Hemosiderosis of the brain is a rare entity. Hemosiderin deposition usually occurs in the subpial region of the superior cerebellar vermis, crests of the cerebellar folia, basal frontal lobe, temporal cortex, brainstem, spinal cord, nerve roots, and cranial nerves I and VIII. The differential diagnosis for hemosiderosis includes hemosiderin deposition resulting from recurrent subarachnoid hemorrhage, neurocutaneous melanosis, and meningioangiomatosis.[1] Recurrent subarachnoid bleeding can result from clinically silent lesions such as cauda equina myxopapillary ependymoma and cavernomas along the neuraxis. The imaging protocol of a patient with hemosiderosis should include MRI of the brain and whole spinal cord and digital subtraction angiography of the brain and spinal cord. Even after extensive evaluation, the cause of hemosiderosis may not be identified in 35% of cases.[2] The causes of hemosiderosis are summarized in [Table 1].[3]
Table 1: Causes of hemosiderosis[3]

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rodriguez FR, Srinivasan A. Superficial siderosis of the CNS. Am J Roentgenol 2011;197:W149-52.  Back to cited text no. 1
    
2.
van Harskamp NJ, Rudge P, Cipolotti L. Cognitive and social impairments in patients with superficial siderosis. Brain 2005;128:1082-92.  Back to cited text no. 2
    
3.
Fearnley JM, Stevens JM, Rudge P. Superficial siderosis of the central nervous system. Brain 1995;118:1051-66.  Back to cited text no. 3
    


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