Radiologically atypical paraganglioma of the filum terminale as a rare cause of superficial siderosis of the central ner
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LETTER TO THE EDITOR
Radiologically atypical paraganglioma of the filum terminale as a rare cause of superficial siderosis of the central nervous system Frédéric London1,2 · Nicolas Mulquin3 · Caroline Fervaille4 · Olivier Lebecque3 · Aleksandar Jankovski2,5 Received: 30 November 2019 / Accepted: 27 February 2020 © Belgian Neurological Society 2020
Introduction Superficial siderosis (SS) is an uncommon but potentially devastating disorder characterized by linear deposits of hemosiderin within the leptomeninges and subpial layers of the brain, infratentorial regions, and spinal cord [1]. The most common underlying causes are dural pathologies (such as traumatic injury or neurosurgical procedures), tumors, and vascular malformations, but the source of bleeding remains frequently undetermined despite extensive imaging [1]. Spinal tumor is, however, a rare cause of SS [1]. Here, we present a case of diffuse SS of the central nervous system caused by a paraganglioma developing in the filum terminale.
Case presentation A 62-year-old man was assessed in our hospital because of a 3-year history of gait difficulties. He also reported profound bilateral sensorineural hearing impairment over a span of 6 years and complained of lower back pain without Frédéric London and Nicolas Mulquin have contributed equally to the work. * Frédéric London [email protected] 1
Department of Neurology, Université catholique de Louvain (UCLouvain), CHU UCL Namur, 1 Avenue G. Thérasse, 5530 Yvoir, Belgium
2
Institute of NeuroScience (IoNS), Université catholique de Louvain (UCLouvain), NEUR Division, Brussels, Belgium
3
Department of Radiology, Université catholique de Louvain (UCLouvain), CHU UCL Namur, Yvoir, Belgium
4
Department of Pathology, Université catholique de Louvain (UCLouvain), CHU UCL Namur, Yvoir, Belgium
5
Department of Neurosurgery, Université catholique de Louvain (UCLouvain), CHU UCL Namur, Yvoir, Belgium
radiculopathy for several years. He denied any heavy traumatism, intradural surgery, or severe headache. Neurological examination showed a wide-based gait with marked difficulty on tandem gait. There were no corticospinal tract signs or urinary symptoms. Cognitive functions were normal. The patient underwent brain magnetic resonance imaging (MRI) with a time gradient echo sequence which showed a diffuse linear hypointensity indicating extensive deposition of hemosiderin along the pial surface of cerebellum and brainstem, in cerebral convexities and sylvian and interhemispheric fissures, consistent with SS (Fig. 1a, b). A full spine MRI was carried out for further evaluation and was remarkable for diffuse T2-weighted hypointensity of the pial surface of the cord (Fig. 1c, d). It also revealed the presence of an intradural extramedullary tumor located at the L5-S1 level, arising from the filum terminale. This lesion was hypointense on T2-weighted images (T2WI) and isointense on T1-weighted images (T1WI), and showed heterogeneous mild enhancement after gadolinium injection; a draining vein was identi
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