Superficial siderosis of central nervous system in patients with brachial plexus injury

✓ Superficial siderosis is a rare condition characterized by deposition of hemosiderin in the leptomeninges and in the subpial layers of the brain and spinal cord. It is associated with cerebrospinal fluid abnormalities consistent with recurrent bleeding into the subarachnoid space. The usual symptoms are hearing loss, ataxia, spastic paraparesis, sensory and sphincter deficits, and mental deterioration. A case is presented of severe superficial siderosis of the central nervous system in a 51-year-old man who had suffered a brachial plexus injury at the age of 20 years. The diagnosis was made by means of magnetic resonance imaging 16 years after the initial symptoms, which comprised bilateral hearing loss and anosmia. Subarachnoid bleeding was due to traumatic pseudomeningocele of the brachial plexus, a very unusual cause of superficial siderosis. This case is interesting insofar as the surgical treatment prevented further bleeding and possibly progression of the disease.

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Delayed central nervous system superficial siderosis following brachial plexus avulsion injury

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.5.11 ◽

2004 ◽

Vol 16 (5) ◽

pp. 1-6 ◽

Cited By ~ 13

Author(s):

Aaron A. Cohen-Gadol ◽

William E. Krauss ◽

Robert J. Spinner

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Brachial Plexus ◽

Vascular Lesions ◽

Superficial Siderosis ◽

Avulsion Injury ◽

Brachial Plexus Avulsion ◽

Potential Source ◽

Hemosiderin Deposition ◽

Symptoms And Signs

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.

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Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

Journal of Clinical Medicine ◽

10.3390/jcm10051013 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1013

Author(s):

Daniel Spitzer ◽

Katharina J. Wenger ◽

Vanessa Neef ◽

Iris Divé ◽

Martin A. Schaller-Paule ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Brachial Plexus ◽

Local Anesthetic ◽

Local Anesthetics ◽

Brachial Plexus Block ◽

Central Nervous System Toxicity ◽

Interscalene Brachial Plexus Block ◽

Plexus Block ◽

System Toxicity

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

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Superficial siderosis of the central nervous system is a rare and possibly underdiagnosed disorder

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170001 ◽

2017 ◽

Vol 75 (2) ◽

pp. 92-95 ◽

Cited By ~ 3

Author(s):

Yara Dadalti Fragoso ◽

Tarso Adoni ◽

Joseph Bruno Bidin Brooks ◽

Sidney Gomes ◽

Marcus Vinicius Magno Goncalves ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Disease Onset ◽

Clinical Findings ◽

Neurological Dysfunction ◽

Superficial Siderosis ◽

Blood Products ◽

The Central Nervous System ◽

Magnetic Resonance Imaging Mri ◽

Intermittent Bleeding

ABSTRACT Superficial siderosis (SS) of the central nervous system (CNS) is a rare and possibly underdiagnosed disorder resulting from chronic or intermittent bleeding into the subarachnoid space, leading to deposition of blood products in the subpial layers of the meninges. Magnetic resonance imaging (MRI) shows a characteristic curvilinear pattern of hypointensity on its blood-sensitive sequences. Methods Series of cases collected from Brazilian centers. Results We studied 13 cases of patients presenting with progressive histories of neurological dysfunction caused by SS-CNS. The most frequent clinical findings in these patients were progressive gait ataxia, hearing loss, hyperreflexia and cognitive dysfunction. The diagnoses of SS-CNS were made seven months to 30 years after the disease onset. Conclusion SS-CNS is a rare disease that may remain undiagnosed for long periods. Awareness of this condition is essential for the clinician.

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