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Superficial siderosis (SS) of the CNS is caused by repeated haemorrhage into the subarachnoid space with resultant haemosiderin deposition in the subpial layers of the brain and spinal cord.1–4 The commonest neurological manifestation is that of slowly progressive gait ataxia and impaired hearing. A remote history of injury is common. A fluid-filled intraspinal cavity of variable dimension is a frequently noted finding on neuroimaging.3–6 A high prevalence of CSF containing cysts in SS supports the hypothesis of bleeding from a dural defect as the origin of SS.7 Removal of the likely bleeding source is a logical therapeutic strategy.
A 58-year-old man was evaluated for a 10 year history of progressive decline in hearing and imbalance. Additional symptoms included a 5 year history of slurred speech and a 1 year history of increasing falls. His past history was remarkable for a motor vehicle accident at 7 years of age. This was followed by a prolonged hospitalisation but no evident neurological sequelae. His examination was remarkable for decreased hearing, …