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Vasculitic Neuropathy – Urgent Immunosuppression — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularVasculitic Neuropathy – Urgent ImmunosuppressionSCE Neurology

A 59-year-old has progressive gait ataxia, bilateral sensorineural deafness and pyramidal signs. Brain susceptibility-weighted MRI shows a continuous hypointense rim over the cerebellum and brainstem, diagnostic of classical superficial siderosis. Which investigation best addresses the treatable mechanism?

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Correct answer: E — Use whole-spine MRI and targeted myelography to locate the bleeding source

Classical superficial siderosis usually reflects chronic low-volume subarachnoid bleeding, often from a spinal dural defect associated with a longitudinal extradural CSF collection. Whole-neuraxis MRI followed by targeted CT or digital-subtraction myelography can localise a repairable defect. Contrast-enhanced spine MRI alone may not localise a rapid leak; catheter spinal angiography is targeted to a suspected vascular source, and cranial CT angiography misses a typical spinal defect. Serial lumbar punctures with ferritin or oxyhaemoglobin can support previous bleeding but cannot locate the source.

Reference: Classical infratentorial superficial siderosis: pathophysiology, clinical features and management (Published 2022): https://pmc.ncbi.nlm.nih.gov/articles/PMC7614629/