”Black Brain and Dark Nerve”—Think Hemosiderosis

Thomas Mathew, Saji K. John, Sharath Kumar, Mithun Sekhar 
 Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Thomas Mathew
Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru – 560034, Karnataka
India

Full Text



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}{Figure 2}{Figure 3}

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}

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References