Investig Magn Reson Imaging.  2018 Dec;22(4):249-253. 10.13104/imri.2018.22.4.249.

Craniopharyngioma with Intratumoral Hemorrhage and Superficial Siderosis

• Oh JH
• Park ST
• Lim HK

• KMID: 2431110
• DOI: http://doi.org/10.13104/imri.2018.22.4.249

Abstract

Superficial siderosis of the central nervous system (CNS) is a progressive and debilitating neurological disease manifesting sensorineural hearing loss, cerebellar ataxia, and pyramidal tract signs. Chronic extravasation of blood into the subarachnoid space results in the accumulation of hemoglobin derivate in the subpial layer of the CNS, which is toxic to the neural tissues. Craniopharyngioma is a benign third ventricle tumor, which rarely presents with tumor bleeding. We report a rare case of superficial siderosis associated with craniopharyngioma with intratumoral hemorrhage in a patient with no history of prior trauma or CNS surgery.

Keyword

Superficial siderosis; Craniopharyngioma; Chronic subarachnoid hemorrhage; Magnetic resonance imaging

MeSH Terms

Central Nervous System
Cerebellar Ataxia
Craniopharyngioma*
Hearing Loss, Sensorineural
Hemorrhage*
Humans
Magnetic Resonance Imaging
Pyramidal Tracts
Siderosis*
Subarachnoid Space
Third Ventricle

Figure

• 

  Fig. 1 (a) Coronal non-enhanced computed tomography (CT) scan shows about 2.3 × 1.8 × 2.0 cm sized isodense suprasellar mass with the focal internal high attenuated area. (b) Contrast-enhanced CT scan demonstrates heterogenous contrast enhancement of the lesion.

• 

  Fig. 2 (a) On coronal T2-weighted image (T2WI), the mass is in the third ventricle, without obstruction of foramen of Monro. No evidence of hydrocephalus is seen. The mass shows high signal intensity (SI) on T2WI and (b) strong, heterogeneous contrast enhancement. (c) On sagittal contrast-enhanced T1-weighted image, the mass is in the anterior aspect of the third ventricle, without involvement of pituitary fossa. (a) Marked T2 low SI foci is noted within the mass, which can be correlated with high density lesion in non-enhanced CT scan, and this finding suggests acute hemorrhage in the mass. (d, e) On axial gradient-echo T2*-weighted images, diffuse linear low SI is noted along bilateral Sylvian fissures and cerebellar sulci, suggesting superficial hemosiderosis. Small amount of intraventricular hemorrhage is noted in bilateral lateral ventricles.

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