An unusual cause of superficial siderosis of central nervous system: A case report of a vestibular schwannoma

Abstract

Vestibular schwannomas are relatively common benign tumors that account for 7-8% of all intracranial tumors. There is a limited number of cases of subarachnoid hemorrhage associated with vestibular schwannoma in the literature. The incidence of symptomatic tumor bleeding is historically reported less than 1%. Susceptibility-weighted imaging (SWI) is a relatively new Magnetic Resonance Imaging (MRI) sequence that is highly sensitive to compounds which distort the local magnetic field such as blood products and hemorrhage. We herein report the rare MRI findings of a 53-year-old man with unilateral vestibular schwannoma and hearing loss who was followed for 4 years. Initial diagnosis of the vestibular schwannoma was made on prior conventional MRI. We included SWI sequence in routine brain MRI protocol. During follow-up, SWI demonstrated focal superficial siderosis due to recurrent subarachnoid hemorrhage seen as hypointense blooming artifacts on the middle cerebellar peduncle-pons junction adjacent to the mass. We think that including SWI in routine MRI protocol will contribute to the initial diagnosis of acoustic schwannoma and detection of its complications such as subarachnoid hemorrhage and subsequent superficial siderosis.

Keywords

• Vestibular schwannoma,Susceptibility weighted image,Superficial siderosis,MRI,Hemorrhage

Santral sinir sistemi yüzeyel siderozisin sıradışı bir nedeni: Vestibüler schwannoma olgusu

Öz

Vestibüler schwannomlar, tüm intrakranial tümörlerin %7-8'ini oluşturan nispeten yaygın görülen iyi huylu tümörlerdir. Literatürde vestibüler schwannoma ile ilişkili az sayıda subaraknoid kanama vakası vardır. Semptomatik tümör kanaması insidansı %1'den daha az olarak rapor edilmiştir. Duyarlılık ağırlıklı görüntüleme (DAG), kan ürünleri ve kanama gibi lokal manyetik alanı bozan bileşiklere karşı oldukça hassas olan yeni bir Manyetik Rezonans Görüntüleme (MRG) sekansıdır. Bu yazıda, 4 yıllık takipteki tek taraflı vestibüler schwannoma ve işitme kaybı olan 53 yaşında erkek hastanın nadir MRG bulgularını bildirmeyi amaçladık. Olgunun vestibüler schwannoma tanısı daha önceki konvansiyonel MRG bulguları ile koyuldu. Takipte kullanılan rutin MRG protokolüne DAG sekansını dahil ettik. Takip sırasında DAG, orta serebeller pedinkül-pons bileşkesinde kitle komşuluğunda hipointens artefaktlar şeklinde izlenen, rekürren subaraknoid kanamaya bağlı fokal yüzeyel sideroz odağını gösterdi. DAG’nin rutin beyin MRG protokolüne dahil edilmesinin, akustik schwannomanın ilk teşhisine, ayrıca subaraknoid kanama ve buna bağlı yüzeysel siderosis gibi komplikasyonların tespitine katkıda bulunacağını düşünüyoruz.

Anahtar Kelimeler

• Vestibuler şvannom,Duyarlılık ağırlıklı görüntüleme,Yüzeyel siderozis,MRG,Hemoraji

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