About this Journal Submit a Manuscript Table of Contents
Case Reports in Neurological Medicine
Volume 2012 (2012), Article ID 745430, 6 pages
http://dx.doi.org/10.1155/2012/745430
Case Report

Superficial Siderosis and Anticoagulation Therapy: Different Presentations, Different Outcomes

Department of Neurology, Entre Douro e Vouga Hospital Center, Rua Dr. Cândido de Pinho, Santa Maria da Feira, 4520-211 Aveiro, Portugal

Received 17 August 2012; Accepted 17 September 2012

Academic Editors: A. E. Cavanna, D. B. Fee, I. L. Simone, and M. Swash

Copyright © 2012 Rui Duarte Barreto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Superficial siderosis is a potentially manageable neurodegenerative disorder, caused by chronic subarachnoid haemorrhage and iron deposition along the central nervous system surfaces. Association with oral anticoagulant therapy is well known, but its definite role as a causative agent is yet to be clarified. Two Caucasian women, both under long-term oral anticoagulation: a 74 year old woman with slowly progressive hearing loss and mild cerebellar ataxia; a 72 year old woman suffering from behavioural changes, rapidly progressive cognitive decline and latter developing paraparesis. Magnetic resonance imaging showed striking hypointensities along the surfaces of cerebellum, brainstem, frontotemporal cortices, spinal cord, and lumbar arachnoid therefore suggesting superficial siderosis. No specific bleeding source was found in any of the patients. Anticoagulation could not be stopped in the first patient due to a mechanic valve and slowly progressive worsening occurred. In contrast, for the second patient anticoagulation withdrawal was feasible and marked motor and cognitive improvement ensued. Superficial siderosis is associated with unvarying progression, mostly when no direct source of bleeding is identified. Nonetheless, we verified striking motor and cognitive improvement after anticoagulants withdrawal in one of the patients. This may reinforce the need to consider such modifiable factor in future patient management.