Delayed central nervous system superficial siderosis following brachial plexus avulsion injury

Report of three cases

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Chronic subarachnoid hemorrhage may cause deposition of hemosiderin on the leptomeninges and subpial layers of the neuraxis, leading to superficial siderosis (SS). The symptoms and signs of SS are progressive and fatal. Exploration of potential sites responsible for intrathecal bleeding and subsequent hemosiderin deposition may prevent disease progression. A source of hemorrhage including dural pathological entities, tumors, and vascular lesions has been previously identified in as many as 50% of patients with SS. In this report, the authors present three patients in whom central nervous system SS developed decades after brachial plexus avulsion injury. They believe that the traumatic dural diverticula in these cases may be a potential source of bleeding. A better understanding of the pathophysiology of SS is important to develop more suitable therapies.

Abbreviations used in this paper:BPI = brachial plexus injury; CSF = cerebrospinal fluid; MR = magnetic resonance; RBC = red blood cell; SS = superficial siderosis.

Chronic subarachnoid hemorrhage may cause deposition of hemosiderin on the leptomeninges and subpial layers of the neuraxis, leading to superficial siderosis (SS). The symptoms and signs of SS are progressive and fatal. Exploration of potential sites responsible for intrathecal bleeding and subsequent hemosiderin deposition may prevent disease progression. A source of hemorrhage including dural pathological entities, tumors, and vascular lesions has been previously identified in as many as 50% of patients with SS. In this report, the authors present three patients in whom central nervous system SS developed decades after brachial plexus avulsion injury. They believe that the traumatic dural diverticula in these cases may be a potential source of bleeding. A better understanding of the pathophysiology of SS is important to develop more suitable therapies.

Abbreviations used in this paper:BPI = brachial plexus injury; CSF = cerebrospinal fluid; MR = magnetic resonance; RBC = red blood cell; SS = superficial siderosis.

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Contributor Notes

Address reprint requests to: Aaron A. Cohen-Gadol, M.D., Department of Neurologic Surgery, St. Marys Hospital, JO 1-229, 1216 Second Street SW, Rochester, Minnesota 55902. email: cohengadol.aaron@mayo.edu.

© Copyright 1944-2019 American Association of Neurological Surgeons

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