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Tanaka A, Ueno Y, Nakayama Y, Takano K, Takebayashi S: Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. Symptoms can vary depending on the distribution of hemosiderin deposition. Hemochromatosis more often requires treatment. J Clin Neurosci. Hemosiderin Staining: Causes, Symptoms, and Treatment - Healthline 2003, 9: 389-390. As the frequency of MBs varies enormously depending on the MRI study characteristics and the selection of the study subjects, the reported prevalence in different clinical conditions has considerably wide ranges: 47% to 80% in ICH [12, 13], 18% to 71% [12, 14] in ischemic stroke, or 17% to 46% in cognitive decline/dementia [15]. 2008, 26: 142-146. Hemosiderosis caused by bleeding and red blood cell breakdown does not usually require treatment. Prevalence of Superficial Siderosis in Patients with Cerebral Amyloid Angiopathy. 2011, 42: 656-661. 2010, 75: 2221-2228. MRI of the Brain II. Regardless of the exact type of lesion involved, the investigation for evidence of chronic hemorrhages in TIA seems crucial, as the simple initiation of anti-thrombotic therapy could have undesirable effects in cases with TFNE. PubMed Central Neurology. 2019;1205:25-53. doi: 10.1007/978-3-030-31904-5_3. . Cerebral microbleeds: overview and implications in cognitive impairment CAS Later, he underwent a computerized tomography chest scan. Clinically, hemosiderin hyperpigmentation is distinguished from postinflammatory dermal melanosis by a golden-brown hue, unlike the brown or gray-blue pigmentation of epidermal or dermal melanin, respectively. Although it is common to see a small amount of hemosiderin deposition at the margins of a previous hemorrhage or surgical resection margin, a single episode of subarachnoid hemorrhage is usually not sufficient to result in this condition 2. An early trial of active immunization reported some cases of severe meningoencephalitis, which prompted its termination [60]. Pettersen JA, Sathiyamoorthy G, Gao FQ, Szilagyi G, Nadkarni NK, St George-Hyslop P, Rogaeva E, Black SE: Microbleed topography, leukoaraiosis, and cognition in probable Alzheimer disease from the Sunnybrook dementia study. Article Further supporting this observation, PiB retention was shown to rapidly decrease with increasing distance from the MB site [24]. Article MRI is the modality of choice for assessment and diagnosis of superficial siderosis. Unauthorized use of these marks is strictly prohibited. Interestingly, in individuals with executive dysfunction, MBs were predominantly located in the frontal lobes and basal ganglia, areas classically considered the neuroanatomical substrate for executive function. 2004, 25: 714-719. Federal government websites often end in .gov or .mil. Hemosiderosis is a term used for excessive accumulation of iron deposits called hemosiderin in the tissues. Springer Nature. Neurology. 2022 Mar 8;10:e13101. There still exists another line of investigation providing support to the link between lobar MB and CAA, and it consists of the study of CAA patients with both MRI and Pittsburgh compound B (PiB)-positron emission tomography (PET) imaging. This site needs JavaScript to work properly. Dierksen GA, Skehan ME, Khan MA, Jeng J, Nandigam RN, Becker JA, Kumar A, Neal KL, Betensky RA, Frosch MP, Rosand J, Johnson KA, Viswanathan A, Salat DH, Greenberg SM: Spatial relation between microbleeds and amyloid deposits in amyloid angiopathy. doi: 10.1136/bcr-2019-230431. Hemosiderin Staining Symptoms, Causes, and Treatments - Vein Directory Symptoms can vary depending on the distribution of hemosiderin deposition. These data are of clinical relevance, suggesting that basal ganglia MRI microbleeds may be a surrogate for ischaemic small vessel disease rather than exclusively a haemorrhagic diathesis. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. Proper recognition and timely early diagnosis of superficial siderosis allow for early care planning. 2009, 40: 1269-1274. Haemosiderin deposition and vascular pathology in the putamen were quantified in 200 brains donated to the population-representative Medical Research Council Cognitive Function and Ageing Study. 10.1161/STROKEAHA.108.531343. Since lobar MBs in the context of AD are interpreted as markers of advanced CAA, lobar MB carriers (especially those with multiple MBs) are currently excluded from immunization trials as a safety measure [63]. These findings fit well with the notion of lobar and deep MBs associated with HV and CAA, respectively. Patients tend to also exhibit other manifestations of hemochromatosis . Hardy J, Selkoe DJ: The amyloid hypothesis of Alzheimers disease: progress and problems on the road to therapeutics. 5. 10.1002/mrm.20198. The site is secure. Cheng AL, Batool S, McCreary CR, Lauzon ML, Frayne R, Goyal M, Smith EE: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. doi: 10.5114/pjr.2021.110650. 1999;20(7):1245-8. Stroke. Terms and Conditions, Stroke. ), The lungs and kidneys are often sites of hemosiderosis. Patients with SS usually present with slowly progressive and irreversible cerebellar ataxia, sensorineural hearing loss, and/or myelopathy due to involvement of the acoustic nerve, cerebellum, and spinal cord. 10.1161/STROKEAHA.111.647271. Superficial hemosiderosis is a neurodegenerative disorder resulting from recurrent leakage of blood into the subpial space. siderosis. This article was published more than 12 months ago and we have therefore closed it for new comments. Analysis of CSF often reveals xanthochromia, red blood cells, and/or elevated protein. 2011, 42: 494-497. Man fr i denne artikkelen inntrykk av at CT thorax, abdomen og bekken inngr i utredningen av demens hos en pasient i 90-rene med tidligere hjernebldning. Stroke. J Alzheimers Dis. Disorders that cause inflammation that lasts for an extended period, such as nonalcoholic fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. Neurology. o [ pediatric abdominal pain ] eCollection 2021. Stroke. Brain. A few longitudinal studies have investigated the progression of MBs over time, revealing that MBs at baseline are a risk factor for the development of new MBs [3537]. 2011, 134: 335-344. 2002, 977: 169-172. 2009, 72: 171-176. Seo SW, Hwa Lee B, Kim EJ, Chin J, Sun Cho Y, Yoon U, Na DL: Clinical significance of microbleeds in subcortical vascular dementia. HV, a consequence of long-standing hypertension over the microvasculature of the brain, is pathologically defined by the presence of lipofibrohyalinosis, which affects mostly the deep penetrating arterioles. On the other hand, several population-based studies have also reported on MB prevalence in healthy older individuals, which can be as high as 23.5% [16]. FOIA Mutations in X-chromosomal WDR45 arise de novo; however, the dominant pattern of inheritance is unusual . 1999;20:637642. Increased level of FAM19A5 is associated with cerebral small vessel disease and leads to a better outcome. Neurology. In a later study on a smaller cohort with longitudinal data, the investigators concluded that high-load amyloid areas are a preferential site for development of incidental lobar hemorrhages [25]. Of 58 patients, deposition was found in the frontal (41.3%), temporal (39.7%), parietal (43.1%), and occipital areas (20.7%) and in the sylvian fissure (65.5%). 10.1212/WNL.0b013e31826043a9. Beta-propeller protein-associated neurodegeneration (BPAN) is the most recently identified subtype of neurodegeneration with brain iron accumulation (NBIA), being unique with respect to the underlying disease genetics, the associated clinical presentation, and the suggested pathomechanism. Hemosiderin deposition in the brain as the footprint of high-altitude cerebral edema. 2013 Jul;20(7):919-27. doi: 10.1016/j.jocn.2012.12.002. CT of the head, thorax, abdomen and pelvis were normal. Bookshelf statement and Hemosiderosis - Blood Disorders - Merck Manuals Consumer Version Magnetic resonance imaging assessment of cerebral small vessel disease intensification in patients with severe aortic valve stenosis. 10.1002/jmri.21029. CAS However, at what time point mild symptoms will progress was entirely based on personal clinical and surgical experience. Stroke. Furthermore, the upgrade of several MRI parameters, such as the magnetic field, has also contributed to a more sensitive detection of MBs [5, 6]. The frequency of MBs in subjects with AD varies significantly across studies (16% to 32%) [15, 4750], with a pooled proportion of 23% (95% CI 17% to 31%) [51]. Neurology. Hemosiderin deposition is the consequence of recurrent or persistent hemorrhage in the subarachnoid space. The body then traps the released iron and stores it as hemosiderin in tissues. Deferiprone, which is a lipid-soluble iron chelator that can penetrate the blood-brain barrier, is reportedly effective at improving the clinical symptoms and deposition of hemosiderin. Would you like email updates of new search results? The long-term bleeding results in a buildup of hemosiderina component of iron storage and deliveryon the brain from circulating CSF. AJNR Am J Neuroradiol. From a pathophysiological standpoint, MBs appear to be the expression of a hemorrhage-prone state of the brain, which might carry a greater risk of ICH. Martinez-Ramirez, S., Greenberg, S.M. 8. Direct bleeding into the tissues that is followed by breakdown of red blood cells and release of iron to the . For instance, 7-Tesla MRI detects twice as many MBs in comparison to conventional 1.5-Tesla MRI [7]. 10.1007/s00401-005-1074-9. 2014, 38: 211-221. Also, the topographic distribution of these MBs has been shown to be potentially associated with specific underlying vasculopathies. 10.1159/000139661. Inform patients that most people with swelling in areas of the brain do not experience symptoms, however, some people may experience symptoms such as headache, confusion, MRI-visible perivascular space location is associated with Alzheimer's disease independently of amyloid burden. Following this, the patient was self-reliant but had moderate cognitive impairments. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada)dedicated to using leading-edge science to save and improve lives around the world. Review of cerebral microangiopathy and Alzheimer's disease - PubMed Google Scholar. Although our knowledge on MB pathophysiology and clinical implications has increased substantially in the last decades, important questions remain unanswered. 10.1212/WNL.0b013e3181eee40f. Gurol ME, Dierksen G, Betensky R, Gidicsin C, Halpin A, Becker A, Carmasin J, Ayres A, Schwab K, Viswanathan A, Salat D, Rosand J, Johnson KA, Greenberg SM: Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. Goos JD, Henneman WJ, Sluimer JD, Vrenken H, Sluimer IC, Barkhof F, Blankenstein MA, Scheltens PH, van der Flier WM: Incidence of cerebral microbleeds: a longitudinal study in a memory clinic population. Werring DJ, Frazer DW, Coward LJ, Losseff NA, Watt H, Cipolotti L, Brown MM, Jager HR: Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI. 1991, 30: 637-649. no financial relationships to ineligible companies to disclose. Cerebral hemosiderin deposition - Tidsskrift for Den norske legeforening Knudsen KA, Rosand J, Karluk D, Greenberg SM: Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. . Hemosiderin - Wikipedia The https:// ensures that you are connecting to the Alz Res Therapy 6, 33 (2014). Alzheimer's Research & Therapy Cite this article. 2008, 65: 790-795. Lewis P. Rowland, Timothy A. Pedley. Stephan Johannes Schler (born 1967), specialist in neurology from Germany, from where he has his dr. Neuroimaging Clin N Am. The Rotterdam Scan Study [16] reported that healthy older individuals with strictly lobar MBs have an exceedingly high frequency of the apolipoprotein E-4 (APOE-4) allele (compared with patients with MBs not strictly confined to lobar regions), which is in agreement with increased APOE-4 frequencies seen in patients with probable CAA. Brain haemosiderin in older people: pathological evidence for an It was also seen that the combination of multiple MBs and retinopathy increased the odds ratio of vascular dementia: 3.10; 95% confidence interval (CI) 1.11 to 8.62 [46]. Greenberg SM, Nandigam RN, Delgado P, Betensky RA, Rosand J, Viswanathan A, Frosch MP, Smith EE: Microbleeds versus macrobleeds: evidence for distinct entities. In a study of individuals with lobar ICH, a higher number of lobar hemorrhages at baseline (including MBs) predicted an increased risk of not only lobar ICH recurrence but also cognitive decline, functional dependence, or death in those individuals not dependent or demented by the time of admission [38]. Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM: Cerebral microbleeds: a guide to detection and interpretation. Biffi A, Halpin A, Towfighi A, Gilson A, Busl K, Rost N, Smith EE, Greenberg MS, Rosand J, Viswanathan A: Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. However, even given the lowest estimates, it appears that MBs are a common phenomenon across different patient populations. represent hemosiderin, calcification, physiological ferritin, melanoma, air, and some paramagnetic contrast agents.7 In particular, T2*-weighted MRI is regarded as a sensitive method for the detection of hemosiderin deposition.8-11 For example, hemosiderin may be detected as an area of signal loss on T2*-weighted images several years after . The most common causes of hemorrhage in the "localized" type are cerebral amyloid angiopathy and/or Alzheimer's disease. The medical history was potentially consistent with Creutzfeldt-Jakob disease, but the 143-3protein in cerebrospinal fluid, which is used as a biomarker for the condition, was normal. Mesker DJ, Poels MM, Ikram MA, Vernooij MW, Hofman A, Vrooman HA, van der Lugt A, Breteler MM: Lobar distribution of cerebral microbleeds: the Rotterdam Scan Study. 10.1212/01.wnl.0000210535.20297.ae. Depending on the amount of iron that remains in the lungs people may have no problems or varying degrees of lung damage. Microhaemorrhages in connection with a previous haemorrhage are typical of amyloid angiopathy. 2012;52(11):947-50. doi: 10.5692/clinicalneurol.52.947. Akoudad S, de Groot M, Koudstaal PJ, van der Lugt A, Niessen WJ, Hofman A, Ikram MA, Vernooij MW: Cerebral microbleeds are related to loss of white matter structural integrity. First, the aforementioned histopathological studies consisted of small series providing very limited observations, especially regarding lobar MBs and CAA. 10.1093/brain/awh253. 2010, 119: 291-302. Hemosiderin deposition is the consequence of recurrent or persistent hemorrhage in the subarachnoid space. The .gov means its official. Avm accounts for 154 of all brain masses most - coursehero.com Before CAS MBs have extraordinary importance in the context of AD. This concept has been studied by comparing the cognitive profile, the rate of cognitive decline over time, and the mortality rates between MB and non-MB subjects with AD. 2012, 79: 320-326. 10.1161/STROKEAHA.106.477315. Cerebral MBs are focal deposits of hemosiderin that indicate prior microhemorrhages around small vessels, related to either ruptured atherosclerotic microvessels or amyloid angiopathy. Stroke. Hemosiderin is also generated from the abnormal metabolic pathway of ferritin.. 2013 The Authors. Superficial Siderosis: Symptoms, Causes, Diagnosis, and More Cordonnier C, van der Flier WM, Sluimer JD, Leys D, Barkhof F, Scheltens P: Prevalence and severity of microbleeds in a memory clinic setting. By using this website, you agree to our Accessibility Choi P, Ren M, Phan TG, Callisaya M, Ly JV, Beare R, Chong W, Srikanth V: Silent infarcts and cerebral microbleeds modify the associations of white matter lesions with gait and postural stability: population-based study. Neurol Med Chir. Kumar N, Miller GM, Piepgras DG et-al. The association between haemosiderin counts and degenerative and vascular brain pathology, clinical data, and the haemochromatosis (HFE) gene H63D genotype were analysed. Methods: 2005, 20: 412-414. J Magn Reson Imaging. Ann N Y Acad Sci. The clinical and prognostic significance of MBs in all these settings remains poorly understood. Enter search terms to find related medical topics, multimedia and more. These two factors may explain the impact of baseline identification of MBs on future neurological events and mortality. Tidsskriftet redigeres etter redaktrplakaten. Histopathological Analysis of Cerebrovascular Lesions Associated With Aging. Neurology. Hemosiderin deposition may be the first sign of a leaky avascular malformation, cyst or aneurysm. Nakata-Kudo Y, Mizuno T, Yamada K, Shiga K, Yoshikawa K, Mori S, Nishimura T, Nakajima K, Nakagawa M: Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascular disease. Swartz J. 1996, 17: 573-578. Individuals with MBs had a much higher prevalence of executive dysfunction than those without MBs (60% versus 30%, P=0.03). Google Scholar. If you do not see the PDF file or want to save the file, you can right-click on the PDF icon. 2012, 78: 326-333. Prognostically a slow progression is usually observed for cerebral hemosiderosis, but a rapid deterioration with a fatal outcome has also been described (2). Cases have been reported in patients between 14 and 77 years of age 5. Aetiologically a haemorrhage (acute or chronic) is present in the subarachnoid space. Careers. There are two types of SS. Neurology. When the ketchup first lands, it is clearly visible, has three dimensional mass and continues to spread. 2009, 17: 599-609. 10.1007/s00415-003-0245-7. PubMed The cautious approach to anti-thrombotic therapy in patients with these symptomatic episodes can be extended to all patients exhibiting MBs. Provided by the Springer Nature SharedIt content-sharing initiative. T2-weighted imaging (WI) or T2* WI demonstrates characteristic linear low-intensity signals along the surface of the brain and spinal cord. Stroke. Arch Neurol. Matsusue E, Inoue C, Matsumoto K, Tanino T, Nakamura K, Fujii S. Yonago Acta Med. MBs were distributed mostly in the cortical areas, predominantly in the fronto-temporal lobes, and this might suggest a high prevalence of CAA in this cohort. eCollection 2022. Again, this predominant MB location matched well with the impaired cognitive areas. AJNR Am J Neuroradiol. This observation raises questions about the pathological significance of MBs and the importance of MB detection in asymptomatic individuals. These results were stronger in subjects with strictly deep MBs. In fact, experimental studies have shown that MBs may transiently affect the function of the nearby cells because of an inhibition of stimulus-evoked calcium responses [31]. In general, the available literature provides support that MBs are independent contributors to cognitive impairment and that their topographic distribution may have specific associations with certain cognitive domains. Superficial siderosis: associations and therapeutic implications. At the time the article was last revised Yahya Baba had Hao Z, Yang S, Yin R, Wei J, Wang Y, Pan X, Ma A. PeerJ. 10.1002/ana.22099. J Neurol. For instance, calcifications, ferritin, and melanoma may appear identical to each other based solely on imaging [5 Takada]. 10.1007/BF00593508. Over time, further sequences have been developed, including three-dimensional T2*-GRE [3] and the most sensitive one to date - susceptibility-weighted imaging (SWI) [4]. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Rodrigues M, et al. parkinsonism, Parkinson-plus syndromes, chorea, myoclonus, ataxia, dystonia, or tremor) 3,4. Three cases of superficial siderosis of the central nervous system and review of the literature. 10.1212/WNL.0b013e3181e396ea. Hemosiderin deposition was found to be increasingly widespread in these patients; however, the specific regions affected varied from case to case. o [ abdominal pain pediatric ] Higher levels of putamen haemosiderin correlated with more CMB (P < 0.003). 2018 Oct;70(10):1107-1113. doi: 10.11477/mf.1416201143. Google Scholar. In the context of Alzheimers disease (AD), several studies have also explored the relationship between MBs and cognition. Two early studies failed to demonstrate any influence of MBs on cognitive performance in AD cohorts [47, 49]. Methods: This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had . PubMed Bookshelf People lose small amounts of iron every day, and even a read more . Over the last decades, the implementation of these MRI sequences in both epidemiological and clinical studies has revealed MBs as a common finding in many different populations, including healthy individuals. 2009, 40: 3455-3460. 2006 Apr 25;66(8):1144-52. doi: 10.1212/01.wnl.0000208510.76323.5b. Check for errors and try again. With this combined approach, a close spatial relationship between MBs and vascular amyloid load was found in a cross-sectional study [24]. 3. Indeed, global cognitive tests (like MMSE) may not capture impairment in certain domains such as executive function. PubMed doi: 10.7717/peerj.13101. 2023 BioMed Central Ltd unless otherwise stated. 10.1159/000092958. 2015 Oct;56(10):590-1. doi: 10.11622/smedj.2015158. Hemosiderin staining can also occur after . Radiology. 2013, 8: e65663-10.1371/journal.pone.0065663. Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P: MR of cerebral abnormalities concomitant with primary intracerebral hematomas. CAS Hsu W, Loevner L, Forman M, Thaler E. Superficial Siderosis of the CNS Associated with Multiple Cavernous Malformations. government site. Unable to load your collection due to an error, Unable to load your delegates due to an error. Second, direct extrapolations from the Boston Criteria for the diagnosis of CAA-related hemorrhage [22] (Table1) seem inadequate, as they have been validated only in subjects with lobar ICH. Hold deg oppdatert om ny forskning og medisinske nyheter. Think of getting a glob of ketchup on a white shirt. Background The Japanese guideline for diagnosis and classification of superficial hemosiderosis (SHS) has recently been published, for which patient medical expenses are supported by the Ministry of Health We sought to clarify the clinical features, method of diagnosis, and treatment for SHS in Japan Methods We sent a questionnaire survey to 792 medical institutes of the Japanese Society of . sharing sensitive information, make sure youre on a federal In this case, low MB counts may have prevented this study from identifying associations. Pract Neurol. However, the clinical and prognostic significance of these small hemorrhages is still a matter of debate as well as a focus of extensive research. Bayer AJ, Bullock R, Jones RW, Wilkinson D, Paterson KR, Jenkins L, Millais SB, Donoghue S: Evaluation of the safety and immunogenicity of synthetic Abeta42 (AN1792) in patients with AD. Neuroimaging studies have consistently reported associations between MB, vascular risk factors (age and hypertension) and previously well-established markers of small-vessel disease (SVD), such as lacunar infarcts and white matter hyperintensities (WMHs) [17]. Cerebral amyloid angiopathy itself is associated with an elevated risk of developing dementia. In long-standing cases, cerebellar atrophy may also be present. A cause of recurrent subarachnoid hemorrhage is present in ~50% of cases 1-6,8: Usually unrewarding; will not demonstrate a point of bleeding 1. Introduction. Hemosiderin is a stain, left behind after a brain bleed, even after though the blood is reabsorbed into the blood system. J Alzheimers Dis. Stroke. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Brain. Tidsskrift for Den norske legeforening, Postboks 1152 Sentrum, 0107 OSLO, Sentralbord: 23 10 90 00 Email: redaksjonen@tidsskriftet.no. The AGES study (n=3,906) [46] showed that the presence of MB, especially multiple MBs, is associated with worse processing speed and executive function. These tumors are often associated with intralesional hemorrhage and hemosiderin deposition; because hemosiderin includes paramagnetic Fe+3 atoms, . Superficial siderosis (SS) of the central nervous system (CNS) results from hemosiderin deposition in the subpial layers of the brain and spinal cord. Neurology, 81 (20 . 2009, 30: 338-343. 2010;74(17):1346-50. Symptoms occur when these hemorrhages cause sufficient irritation in the surrounding brain to produce seizure activity or when the lesions reach sufficient size to compress adjacent neurological structures. The trusted provider of medical information since 1899. Neurology. The implementation of more sensitive MRI techniques for the detection of MBs, and their systematic assessment along with other imaging markers (including PET-based amyloid imaging [24]) and blood biomarkers, may provide a useful tool in the future to guide therapeutic decisions and better define subjects in a research context. Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, Greenberg SM, Dickerson BC: MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. These results suggested that (a) MBs may actually have a negative effect on cognition, independently of other concurrent vascular lesions, and (b) there seems to be an anatomical correlation between the distribution of MBs and the cognitive domains affected, suggesting a direct damage of MBs over the tissue as the pathogenic mechanism. As both entities are associated with age, they may coexist in a single individual, with variable degrees of severity [8]. PubMed In "classical"-type SS, hypointense MRI signals are observed in the brainstem and cerebellum with diffuse and symmetrical margins. Although deep MBs may be identified in some AD cases, the vast majority of them (92%) show a lobar predominance. Neuroimaging in Superficial Siderosis: An In-Depth Look 10.1002/ana.410300503. However, it is important to note that only a small proportion of AD cases (23%) actually exhibit lobar MBs [51].