title: A case of superficial siderosis ameliorated after closure of dural deficit detected by MRI-CISS (constructive interference in steady state) imaging.
abstract: A 64-year-old male developed headache, dizziness, and difficulty hearing, two years after an operation for chronic subdural hematoma due to head injury. These symptoms gradually worsened over the following 15 years. As he showed bloody cerebrospinal fluid (CSF) and marginal hypointensity on the surface of the brain and spinal cord on T2/T2*-weighted MRI, he was diagnosed with superficial siderosis (SS), although the source of the bleeding was unclear and anti-hemorrhagic drugs were ineffective. When he was admitted to our hospital, neurological examination disclosed horizontal gaze-evoked nystagmus, severe bilateral hearing loss, scanning speech, and limb and truncal ataxia. CISS (constructive interference in steady state) MRI detected a dural defect at the Th2-3 level on the anterior side of the spinal canal. On operation, a 2 mm × 6 mm size dural defect with blood clots was found at the Th2-3 level. After closure of the dural defect, bloody CSF became transparent, and his persistent headache, dizziness, and hearing impairment improved. Brain and whole spine MRI, especially CISS imaging, should be considered for detecting the source of bleeding in intractable cases of SS.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Ayako
authors.initials: A
authors.lastname: Sakoda
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Ken-Ichiro
authors.initials: KI
authors.lastname: Yamashita
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hayashida
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Jun-Ichi
authors.initials: JI
authors.lastname: Kira
mesh_terms: D004388:Dura Mater / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D020200:Hematoma, Subdural, Chronic / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012806:Siderosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome
keywords: CISS; dural closure; dural defect; superficial siderosis