Acad Radiol. Most patients will go to a dermatologist or primary care physician for the skin condition, not the underlying vein disease of hemosiderin staining. Your organization or institution (if applicable), e.g. 2012 Apr;32(4):E7. What does hemosiderin mean in medical terms? [, Tllez-Zentenoa JF, Hernndez Ronquilloa L, Moien-Afshari F, et al. The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. Hard windowing of the FLAIR weighted sequences will make identification of the diseased hippocampus easier. In contrast to the first-ever seizure, patients diagnosed with epilepsy have recurrent and unprovoked seizures. Staining occurs as hemosiderin accumulates in our tissues, then deposits iron, which creates a reddish-brown or bruise-like appearance. 2013;49:7987. (a, b) Boy, 6months. [, Howe KL, Dimitri D, Heyn C, et al. Hemosiderin is an insoluble form of tissue storage iron, being found at the level of different cells (not in the circulating blood). (a) axial T2; (b) coronal T1. Greenberg SM, Eng JA, Ning M, Smith EE, Rosand J. Stroke. In the early stages of MTS the imaging findings are subtle with loss of the internal architecture of the hippocampus with or without associated FLAIR signal changes. 2022 Oct 6;14(10):2120. doi: 10.3390/pharmaceutics14102120. Which of the following structure contains osteocytes? Results: Most women aged 2050 years consumed less dietary iron than their recommended dietary allowances. ResultsMicrobleed prevalence gradually increased with age, from 6.5% in persons aged 45 to 50 years to 35.7% in participants of 80 years and older. 2008;10:8392. This test may also be used to evaluate for suspected chronic venous insufficiency[2]. Identification of the stratum lacunosum as a landmark provides an imaging reference point for qualitative and quantitative analysis of tissue loss in MTS. Hemosiderin is also generated from the abnormal metabolic pathway of ferritin.. Further studies to characterize the associated risks of cerebral microhemorrhages in different stroke populations are needed to use this new imaging marker in therapeutic decisions. Pathophysiology. If you recognize the underlying cause early and start managing the condition, the stains may fade somewhat over time. Cham (CH): Springer; 2020. Typical symptoms include 2-5: sensorineural hearing loss most common, found in ~95% of patients bilateral and gradual cerebellar dysfunction (ataxia): ~90% pyramidal signs: ~75% other less common findings include dementia bladder incontinence other cranial nerve dysfunction [, Vattoth S, Manzil FFP, Singhal A, et al. Female carriers of the affected X-chromosome present with band heterotopias that is more present in the frontal lobes compared to the parietal lobes. While cavernomas that are deeply located in the white matter rarely cause seizures, those that are cortically located and have hemosiderin staining reaching the cortex, and in particular the mesial temporal lobe structures, are very often associated with seizures as the hemosiderin stain is believed to have a strong irritative potential for neurons. (a) axial and (b) coronal FLAIR images at standard window level setting as compared to narrowed window width setting of the same images in (c, d) which makes the lesion more conspicuous. The findings shown are relatively subtle. With the advent of modern MRI imaging techniques, cerebral microhemorrhages have been increasingly recognized on gradient-echo (GE) or T2*-weighted MRI sequences in different populations. (a, b) Patient 1. Patient 1. Go to Neurology.org for full disclosures. doi: 10.3171/2012.1.FOCUS11370. Neuropathological diagnoses were predicted correctly in 22% of non-expert standard MRI reports but by 89% of dedicated MRI reports. In addition, diffusion tensor imaging has shown a subset of patients with hemimegalencephaly harbor aberrant midsagittal fiber tracts with intra- or interhemispherically connection which may need to be surgically addressed to improve surgical outcome [17]. Save my name, email, and website in this browser for the next time I comment. When the ketchup first lands, it is clearly visible, has three dimensional mass and continues to spread. 10.18). What Causes Encephalomalacia? Virtually any infection (bacterial, fungal, parasitic) can produce epileptogenic lesions, and world-wide, infections are the leading cause of epilepsy. The atrophy will lead to loss of the pes hippocampi interdigitations, widening of the temporal horn and atrophy of the white matter of the temporal lobe. shortness of breath, especially when exercising. Often these patients have some form of cognitive impairment or developmental delay. Recurrent seizures might cause hippocampal damage or dysfunction. Within <1 to 38 months after the qualifying incident, MRI of the brain was performed using a 3-tesla scanner and high-resolution susceptibility-weighted magnetic resonance sequences for detection of hemosiderin depositions, which were quantified by a score. Dipole source analysis using either EEG or MEG data can also be added for the localization of seizure activity. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. J Neurol Neurosurg Psychiatry. Red areas indicate activation during a simple word generation task. (ac) Two patients with polymicrogyria. Lipofuscin or ceroid pigment also is normally present in macrophages scattered throughout the red pulp and can be demonstrated by acid-fast stains. there are no medical or medication issues. A variety of non-radiological adjunct tests are available that may help in the localization of the seizure focus and preferably these challenging cases are therefore discussed in multidisciplinary conferences. [, von Oertzen J, Urbach H, Jungbluth S, et al. In adults, solid appearing ganglioglioma may mimic high grade glioma and advanced imaging techniques such as MR perfusion maybe a useful tool for pre-operative evaluation (Fig. To clarify the cause of HPR, we used 3 staining methods: the Klver-Barrera method to observe the myelin sheath, the Berlin blue method to observe hemosiderin, and ferritin immunohistochemistry to observe ferritin. The blood pools under the skin and leave a residue of hemoglobin that settles in the tissue there. CMBs are, Due to neurological decline, this condition is. A typical example is neurocysticercosis which is a very common cause of focal epilepsy in the developing world. From the Department of Internal Medicine, Division VII: Sports Medicine (K.S., P.B. (ac) Tuberous sclerosis; (a) axial T2 and (b) coronal T2FLAIR show subependymal hamartomas and widespread cortical and subcortical signal changes; (c) axial T1 with gadolinium with a large giant cell astrocytoma in a classical position, close (more), (ac) SturgeWeber syndrome; (a) axial CT shows curvilinear cortical calcifications in the right occipital lobe; (b) axial T1 without and (c) with gadolinium shows contrast enhancement caused by pial angiomatosis. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. Clin Nucl Med. Causes of hemorrhage in the "classical" type include tumor, vascular abnormality, injury, and dural defect. A Cross-Sectional Study in an Unselected Cohort, Neurology | Print ISSN:0028-3878 Pharmaceutics. AVMs in the temporal lobe have a higher likelihood of producing seizure due to interference of the normal blood supply and drainage of potentially epileptogenic structures such as the hippocampus. Many other pathologies including tumors, vascular malformations, phakomatoses, or remote infections can cause medication refractory epilepsy especially if the structures involved are close to the mesial temporal lobe structures. Hemosiderin staining is a medical condition in which one presents yellow or brown patches on the skin. (a, b) patient 1; (a) coronal T2 with large subcortical area in the right temporal lobe with prolonged T2. (f) CT scan confirms the calcification, (ac) Tuberous sclerosis; (a) axial T2 and (b) coronal T2FLAIR show subependymal hamartomas and widespread cortical and subcortical signal changes; (c) axial T1 with gadolinium with a large giant cell astrocytoma in a classical position, close to the foramen of Monroe in the left lateral ventricle, (ac) SturgeWeber syndrome; (a) axial CT shows curvilinear cortical calcifications in the right occipital lobe; (b) axial T1 without and (c) with gadolinium shows contrast enhancement caused by pial angiomatosis. Hemosiderin is a brown iron-containing pigment usually derived from the disintegration of extravasated red blood cells (1.40). Your white blood cells, or immune system cells, can clear up some of the excess iron released into your skin. It is thought that the hemosiderin deposition associated with cavernous angiomas may play a role in triggering seizures. The increased signal stretches in to the temporal horn of the right ventricle; (b) coronal T1 with gadolinium. Diagnostic methods and treatment options for focal cortical dysplasia. Microbleeds in the Corpus Callosum in Anoxic Brain Injury. What does hemosiderin staining look like? 2014;85:5818. In selected patients, i.e., those with medication refractory epilepsy, abnormalities can be found in a high percentage if images are performed with a dedicated imaging protocol, and expert read-out. You must have updated your disclosures within six months: http://submit.neurology.org. 1 The blood that is supposed to go up towards the heart flows backward into the veins in the legs, causing blood to pool. From: Human Biochemistry (Second Edition), 2022 Add to Mendeley Download as PDF About this page Bone Marrow, Blood Cells, and the Lymphoid/Lymphatic System1 2020 Sep;81(5):1184-1193. doi: 10.3348/jksr.2019.0113. Your white blood cells, or immune system cells, can clear up some of the excess. These capillary blood leaks can be caused by a number of things . Epilepsia. The body then traps the released iron and stores it as hemosiderin in tissues. An official website of the United States government. official website and that any information you provide is encrypted Discover some of the causes of dizziness and how to treat it. Definition of hemosiderin : a yellowish-brown, iron-containing, granular pigment that is found within cells (such as macrophages), is composed chiefly of aggregates of ferritin, and is typically associated with bleeding and the breakdown of red blood cells (as in hemolytic anemia), In some cases, this treatment may leave the patient with brown skin discoloration as a result of hemosiderin (iron) deposits. Hemosiderin collects in the skin and is slowly removed after bruising; hemosiderin may remain in some conditions such as stasis dermatitis. This is actually a protein that is insoluble and contains irons, being produced by the digestion of the hematin by the phagocytes. What is hemosiderin staining in the brain? 2010;31:16829. Hemosiderin is water-insoluble and thermally denatured, but ferritin is water-soluble and heat-resistant up to 75C. It is believed that in these cases the other epileptogenic lesion triggered the mesial temporal lobe sclerosis (similar to febrile seizures as a child can trigger or kindle a mesial temporal lobe sclerosis). Online ISSN:1526-632X, The most widely read and highly cited peer-reviewed neurology journal. Access for 1 day (from the computer you are currently using) is US$ 39.00. (a, b) Right hippocampus internal architecture: (a) coronal T2 at 3T showing an inner hypointense layer of the hippocampus representing the stratum lacunosum; (b) at 1.5T the ultrastructural detail of the hippocampus is obscured due to the decreased spatial (more), (a, b) Mesial temporal sclerosis (MTS): (a) coronal T2FLAIR shows increased signal in the left hippocampus; (b) axial T1IR demonstrates volume loss in the left hippocampus. Your role and/or occupation, e.g. Differential diagnoses for gangliogliomas are DNETs, pilocytic astrocytomas, pleomorphic xanthoastrocytomas, gliomas, and neurocysticercosis. Clinical features of high-degree centrum semiovale-perivascular spaces in cerebral amyloid angiopathy. Epilepsy Res. Distributing copies (electronic or otherwise) of the article is not allowed. National Library of Medicine 2012;135:134869. (ac) Periventricular nodular heterotopia: (a) coronal T1; (b) sagittal T2; (c) axial T1IR. Before As a result, you may notice yellow, brown, or black staining or a bruiselike appearance. The cortex lining the defect is polymicrogyric with ill-defined margins to the white matter. Hemosiderin staining can occur in people with venous ulcers, which are slow-healing or non-healing wounds caused by blood pooling in the veins. As a result, they may not get an accurate diagnosis. It is generally recommended that for an epilepsy-specific protocol T2FLAIR, T2/STIR in two parallel planes, T2 gradient echo/SWI sequences, and an isotropic 3D-T1 are necessary. Laz Haque T, Miki Y, Kanagaki M, et al. In a landmark study of von Oerzten et al. 2022 Sep;43(9):E19-E35. Malformations related to abnormal stem cell development include the focal or transmantle cortical dysplasias (balloon cell or type II FCDs) and the hemimegalencephalies. The transmantle sign is a specific radiologic feature of FCD type II, which is more frequently detected in patients with FCD type IIb than FCD type IIa. Web page addresses and e-mail addresses turn into links automatically. Mehndiratta P, Manjila S, Ostergard T, Eisele S, Cohen ML, Sila C, Selman WR. Hemosiderin staining can also occur after . Am J Neuroradiol. CMBs are associated with subsequent hemorrhagic and ischemic stroke, and also with an increased risk of cognitive deterioration and dementia. Nat Rev Neurol. Read any comments already posted on the article prior to submission. Hemosiderin staining occurs when red blood cells are broken down, causing hemoglobin to be stored as hemosiderin. Radiologic and pathologic features of the transmantle sign in focal cortical dysplasia: the T1 signal is useful for differentiating subtypes. Hemosiderin staining is caused by an accumulation of iron in the tissues. The corresponding area has decreased signal on T1-weighted image. Patient 1. Hemosiderin or haemosiderin is an iron-storage complex that is composed of partially digested ferritin and lysosomes.The breakdown of heme gives rise to biliverdin and iron. Hemosiderin is a particle representing an iron storage complex that is formed by the breakdown of hemoglobin or an abnormal metabolic pathway of ferritin. In patients with ischemic cerebrovascular disease, microhemorrhage number and location may be associated with executive dysfunction and may predict the occurrence of ICH and lacunar infarction. When blood leaks from capillaries, it collects under the skin and the red blood cells break down. The radiological finding in routine MR imaging, especially the hemosiderin signal around the lesions, strongly support the diagnosis of CA. A dedicated epilepsy protocol is necessary to identify these lesions and the MR should be interpreted in conjunction with EEG, MEG, neuropsychological testing, and clinical semiological data to increase the likelihood of identifying these often very subtle lesions. (a) axial T2FLAIR with a small, cortical/subcortical, nodular high-signal area in the right parietal lobe close to the postcentral sulcus; (b) coronal T1 with gadolinium shows contrast enhancement (more), Right superior temporal gyrus ganglioglioma in a middle-aged patient. The blood pools under the skin. The left hemisphere is enlarged with broad gyri and shallow sulci. In "localized"-type SS, hypointense MRI signals are localized in the cerebral cortex. Your last, or family, name, e.g. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. If you have a subscription you may use the login form below to view the article. Brain. Cortical dysplasias (coined type III) can be associated with a ganglioglioma. Hemosiderin deposition in the brain is seen after bleeds from any source, including chronic subdural hemorrhage, cerebral arteriovenous malformations, cavernous hemangiomata. on the prevalence of epileptogenic lesions among 2740 patients the following pathologies were found: mesial temporal lobe sclerosis (32%), tumors (including low and high grade tumors as well as malformative tumors and benign epilepsy associated tumors) in approximately 17% of patients, cortical dysplasias in 11%, glial scars (including posttraumatic, post-ischemic, post-hemorrhagic, postinfectious/abscess, ulegyria, and postsurgical scars) in 11%, vascular diseases (cavernoma AVM, pial angiomatosis) in 5%, malformations of cortical development including nodular heterotopia, subcortical band heterotopia, polymicrogyria, lissencephaly, pachygyria, agenesis of corpus callosum, craniocephalic malformations, hemiatrophy, lobar dysgenesis, hemimegalencephaly, or hamartomas in 3%, and sequelae of encephalitis in 1% while in approximately 20% no lesion could be detected. 2013;54:759. Imaging evaluation should be standardized using a stepwise approach to evaluate the hippocampus and mesial temporal lobe structures, the ventricular outline, the gyral, and the sulcal anatomy. The herniated brain demonstrates high T2/FLAIR signal and is believed to be the epileptogenic focus. Dedicated MRI showed focal lesions in 85% of patients with non-lesional standard MRI. Disclaimer. New directions in clinical imaging of cortical dysplasias. If hemosiderin is present in increased amounts without an obvious explanation, further investigation is warranted. Lipofuscin or ceroid pigment also is normally present in macrophages scattered throughout the red pulp and can be demonstrated by acid-fast stains. Bleeding in the spinal cord can cause difficulty with movement or feeling in the legs and sometimes arms, as well as bowel and bladder symptoms. Indistinct gray/white matter is noted throughout the entire hemisphere, (a, b) X-linked lissencephaly, boy, 2weeks old. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. [, Winstona GP, Micallef C, Brian E, Kendell BE, et al. AVMs in the temporal lobe have a higher likelihood of producing seizure due to interference of the normal blood supply and drainage of potentially epileptogenic structures such as the hippocampus. Thank you! 2013 Nov;39(8):955-62. doi: 10.1055/s-0033-1357489. 2014;124:5965. 2002;73:6437. The amount of time needed to resolve a hemosiderin stain depends on the size and intensity of the stain, as well as the type of treatment used to resolve it. Dietary iron intake was inversely associated with severe headache or migraine in women aged 2050 years. Results: Unequivocal MHs located in the splenium of the CC were found in 8 subjects and questionable MHs were found in 2 subjects 1 to 35 months after HACE. If you do notice leg discoloration, or hemosiderin staining, take action. Correlation of lipoprotein-associated phospholipase A2 and cerebral microbleeds in patients with acute ischaemic stroke. [, De Ciantis A, Barkovich AJ, Cosottini M, et al. MeSH Identification of the second focus is of great importance as failure to do so may result in surgical failure if only a selective amygdalohippocampectomy is performed thus leaving the primary focus behind. [, Balchandani P, Naidich TP. Being unprovoked, lesions that can irritate the brain (i.e., are epileptogenic) may be present. If the perinatal ischemia has only involved one hemisphere (perinatal stroke) a Dyke Davidoff Mason syndrome will ensue where stable hemiatrophy is present with hypertrophy of the skull and the sinuses, paucity of white matter, ventricular enlargement, and mild gliosis. 'MacMoody'. When cerebral microhemorrhages are diagnosed on MRI, conclusions regarding their significance and associated risks should be made based on the population examined. Sign Up In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease. 2014;39:51126. [, Bauer PR, Reitsma JB, Bernard M, Houweling BM, et al. As a consequence of Wallerian degeneration, there will be atrophy of the projecting pathways of the hippocampus, i.e., the Papez circuit, with atrophy of the ipsilateral fornix and the mammillary body. (c) T1 inversion recovery reveal (more). As a general discussion of all tumors is beyond the scope of this chapter, we will focus only on three tumors that are commonly associated with seizures: the gangliogliomas, the DNETs, and the tuber cinereum hamartomas. You quickly wipe it off, stop the spreading. Atrophy of the hippocampus and gliosis within the hippocampus will manifest itself as increased signal intensity on T2/FLAIR sequences (Fig. Functional MRI (fMRI) can map eloquent cortex and provide information regarding language lateralization [, Radionuclide imaging can add useful information in selected cases [. The increased signal stretches in to the temporal horn of the right ventricle; (b) coronal T1 with gadolinium. Am J Neuroradiol. This susceptibility (more). [, Strandberg M, Larsson EM, Backman S, et al. Histologically confirmed hippocampal structural features revealed by 3T MR imaging: potential to increase diagnostic specificity of mesial temporal sclerosis. Imaging features are very subtle and only mild focal blurring of the graywhite matter junction may be present. Patients with a thick band have less normal cortex (that can be thinned) and thus present with a more severe developmental delay. 8600 Rockville Pike It is a ferritin complex and it is important to understand that the iron that it . ResultsMicrobleed prevalence gradually increased with age, from 6.5% in persons aged 45 to 50 years to 35.7% in participants of 80 years and older. (a) coronal T2; (b) sagittal T1 with gadolinium; well delineated cortical/subcortical bubbly mass in the right frontal lobe with prolonged T2 and no contrast enhancement typical of a DNET. 10.17). Access to this article can also be purchased. Lesions with a strong epileptogenic potential are either close to epileptogenic structures or consist of abnormal neurons. In these patients, structural imaging will find abnormalities in up to 85% of patients. Hemosiderin staining usually happens on the lower leg, near the ankles, or on your feet. 2013;105:34955. Zhang X, Liu L, Jiang N, Liu Y, Wang Q, Tang X, Zhai Q, Zhao L. BMC Neurol. (a, b) Right lateral precentral gyrus type II FCD. Imaging abnormalities encountered in patients experiencing their first-ever seizures include (but are not restricted to) virtually all diseases affecting the brain. You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid Neurosurg Focus. [2], the sensitivity of non-expert reports of standard MRI reports for focal lesions was 39%, while sensitivity of expert reports of standard MRI increased to 50%. If you are uploading a letter concerning an article: Histologically the transmantle sign reflects abnormal cells extending from the ventricle to the cortex manifesting as a linear T2-weighted or FLAIR hyperintensity from ventricle towards the cortex (the radial band or foot) and can be seen in association with a subcortical FLAIR hyperintensity. 3 Hemosiderosis (hemosiderin deposition) Hemosiderosis is a medical condition resulting from the excessive accumulation of hemosiderin in different parts of the body. Semin Thromb Hemost. Epilepsy imaging at 1.5T is in the opinion of the authors no longer acceptable. 1. The analysis of the BAL revealed an increased number of total cells, with an acute inflammatory reaction that resolved within 2 weeks. Overall, 15.3% of all subjects had at least 1 CMB. (a, b) Hypothalamic hamartoma. More guidelines and information on Disputes & Debates, Neuromuscular Features in XL-MTM Carriers: Hemosiderin and ferritin are iron-containing proteins with magnetic susceptibility. This type of dysplasia is often undetectable on MRI. If you do notice leg discoloration, or hemosiderin staining, take action. Lancet Neurol. Hemosiderin collects in the skin and is slowly removed after bruising; hemosiderin may remain in some conditions such as stasis dermatitis. To appreciate the importance of additional clinical information when evaluating the patient with medication refractory epilepsy. Too much iron can lead to life-threatening conditions, such as liver disease, heart problems and diabetes. (c, d) The mother of the boy in (a, b) female carrier. Imaging findings of first-ever seizure patients are in most cases normal, and abnormalities are only present in approximately 15% of patients as seizures can be provoked by fever, sleep deprivation, stroboscopic lights, or drugs. Patients with previous trauma can experience posttraumatic seizure disorder, especially after having sustained contusional hemorrhages of their temporal lobes as gliosis and hemosiderin staining can cause irritation of the surrounding cortex. Interictal PET and ictal subtraction SPECT: sensitivity in the detection of seizure foci in patients with medically intractable epilepsy. The major focus of this chapter will be on the imaging findings in those patients who are diagnosed with medication refractory epilepsy, i.e., patients where the seizure focus is too strong to be controlled by medication which indicates that the underlying lesion has to have a strong epileptogenic potential. Mesial temporal lobe sclerosis is the most commonly seen cause for medication refractory epilepsy and is characterized by an indistinct graywhite matter differentiation, abnormal high signal on T2/Flair sequences, and atrophy. [. Results: Hemosiderin staining within alveolar macrophages was first detected in the BAL and lung tissue at day 3, peaked at day 7, and persisted through 2 months. Duncan JS. Hemosiderin is a brown iron-containing pigment usually derived from the disintegration of extravasated red blood cells (1.40). New intra-cavernomatous thrombosis or hemorrhage may lead to change in seizure frequency. Schizencephaly can be multifocal and bilateral. [, Gaitanis JN, Donahue J. Focal cortical dysplasia. Hemosiderin deposition in the brain is seen after bleeds from any source, including chronic subdural hemorrhage, cerebral arteriovenous malformations, cavernous hemangiomata. This form of harm could result from significant accidents, hemorrhages, botched surgeries, etc. Diseases of the Brain, Head and Neck, Spine 20202023: Diagnostic Imaging [Internet]. A multidisciplinary approach that involves close communication between epilepsy neurologists, neuroradiology, EEG, nuclear medicine, neuropsychology, and neurosurgery is an important feature of modern epilepsy management. Type II FCD is characterized on histology by dysmorphic neurons with or without balloon cells in addition to cortical dyslamination and are identical to cortical hamartomas in tuberous sclerosis. Hemosiderin is a particle representing an iron storage complex that is formed by the breakdown of hemoglobin or an abnormal metabolic pathway of ferritin. Aberrant midsagittal fiber tracts in patients with hemimegalencephaly. Signal intensity of the transmantle sign on the T1-weighted sequence could reveal the histologic composition of the type II FCD. On imaging an exophytic smooth ovoid mass in the residual germinal matrix, i.e., along the ventricle is seen (Fig. Malformations of cortical development are present in up to 25% of patients with intractable childhood epilepsy. Two patients with DNET. This protocol should take into account thatas small epileptogenic lesions are usually those that provide the best chance for postoperative seizure freedomslice thickness should be adjusted to detect small lesions and multiple (coronal, axial, sagittal) cut planes are acquired to ensure that physiologic structures or partial volume effects within the folded cortex are not taken for pathology and vice versa. In normal animals, hemosiderin deposits are small and commonly inapparent without special stains.
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