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.

Case report

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, …