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Washington University Experience | TRAUMA & FORENSIC | Contusions | 25C Case 25 Denouement
Case 25 Denouement ---- Sections of the cerebral cortices show scattered accumulations of hemosiderin-laden macrophages within the meninges, typically corresponding to the areas of red-brown gross surface discoloration. There is otherwise no evidence of meningeal inflammation, purulent exudate, or fresh hemorrhage. The neocortices show a well-maintained complement of neurons without concomitant astrocytic or microglial proliferation, i.e. they appear surprisingly relatively undamaged. Sections from the right cerebellum show loss of granular cell layer and scattered Purkinje cell drop-out with accompanying Bergmann gliosis with scattered hemosiderin-laden macrophages, astrocytes and microglia. ---- The extensive red-brown meningeal pigmentation, accumulation of pigment-laden Bergmann glia within the cerebellum, and right cerebellar hemispheric atrophy are quite suggestive of a condition referred to as superficial siderosis. Patients with this condition typically have sources of presumably repetitive hemorrhage in the CNS space, eventually leading to irritation of meningeal vessels and subsequent atrophy of underlying structures, most notably the cerebellum in some forms. The possibility that this case represents superficial siderosis is considered. The distribution of involvement is trauma-stereotyped and there is no other source of hemorrhage in this case, so we have settled on a basic contusive insult as the source of local hemorrhage. This is not a yes/no separation since chronic trauma is one of the conditions associated with superficial siderosis. Symptomatology related to this condition are progressive over years, with unsteadiness of gait, cerebellar signs, and pyramidal signs, as well as other neurologic deficits. In this patient with a history of seizures, the most likely cause of repeated bleeding is trauma to the head, as no other gross or microscopic sources of bleeding were evident. (see Kumar, Superficial siderosis, PMID: 33860558)
