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Underlying pathology of superficial siderosis demonstrated on CISS MRI

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MRI in a 69-year-old woman with slowly progressive gait disturbances and hearing impairment. Noncontrast sagittal constructive interference in steady state (CISS) MRI of the cervical and upper thoracic spine shows an anterior wedge degenerative deformation of the T6 vertebral body with a superimposed prominent central disc extrusion characterized by osteo-calcific signal (yellow arrow) causing a dural tear at the T6-T7 level. Above the disc extrusion, note the “sentinel” epidural fluid collection (red asterisk) stretching along the ventral aspect of the spinal canal and displacing the dura posteriorly. CISS MRI shows low signal intensity along the surface of the spinal cord consistent with superficial siderosis (yellow arrowhead). (Source: Bonomo G, Cusin A, Rubiu E, et al. Diagnostic approach, therapeutic strategies, and surgical indications in intradural thoracic disc herniation associated with CSF leak, intracranial hypotension, and CNS superficial siderosis. Neurol Sci 2022;43[7]:4167-73. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)