Indicators of true intracerebral hemorrhage: hematoidin, siderophage, and erythrophage.

A 50-year-old woman with a right cerebellopontine-angle schwannoma developed a chain of complications after multiple surgeries for tumor resection including intracerebral and subarachnoid hemorrhage, hydrocephalus, and fungal meningitis with subarachnoid pyogenic loculations. After 2 months of routine monitoring, cerebrospinal fluid (CSF) examination revealed increased red blood cells (RBCs), neutrophils, monocytes, and macrophages. Wright-Giemsa staining revealed golden brown rhomboid crystals of hematoidin (panel A) and coarse granules of hemosiderin (panel B) in the macrophages (siderophages). Along with the presence of macrophages with ingested RBCs (erythrophages; panel C), these findings indicate an acute and chronic hemorrhage.