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Case Reports
. 2024 Sep 20;16(9):e69768.
doi: 10.7759/cureus.69768. eCollection 2024 Sep.

Superficial Siderosis: A Case Report of Underdiagnosed Disorder

Tural Talibov  1 , Meltem Inci  2 , Mehmet Barburoglu  3 , Altay Sencer  4 , Oguzhan Coban  5
Affiliations
Case Reports

Superficial Siderosis: A Case Report of Underdiagnosed Disorder

Tural Talibov et al. Cureus. .

Abstract

Superficial siderosis (SS) is caused by subpial hemosiderin deposition due to chronic low-grade bleeding into the subarachnoid space. Dural tears are the most common etiology. Slowly progressive gait ataxia and hearing impairment are common clinical manifestations. Brain magnetic resonance imaging (MRI) shows linear superficial hypointensity on the T2 weighted images and gradient echo. The therapeutic approach is surgical repair of the bleeding source. The patient presented with progressive hearing loss and ataxia. Neurological examination revealed bilateral hearing loss, nystagmus, dysarthria, brisk deep tendon reflexes, and severe ataxia. Brain MRI showed linear superficial siderosis in the cerebrum, cerebellum, and brain stem. Spinal MRI showed ventral epidural cerebrospinal fluid (CSF) collection and disc-osteophyte complex. Six months after the surgical repair of the dural defect, the patient's neurological examination demonstrated improvement in ataxia and dysarthria. The patient was able to walk without any assistance. Surgical repair of the underlying bleeding source may be beneficial in preventing the progression and improving the symptoms of superficial siderosis SS. This case suggests that SS symptoms are potentially reversible by surgical treatment of the underlying spinal CSF leak after a long disease course.

Keywords: cervical dural defect; progressive ataxia; progressive hearing loss; spinal csf leak; superficial siderosis.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The axial and sagittal brain and spinal MRI from patient
Axial gradient echo (A) and T2-weighted (B-C) brain MRI showing signal hypointensity due to hemosiderin deposition along the cerebral convexities (A), around the midbrain (B), and along the cerebellar folia (C). The T2-weighted axial (D) and sagittal (E) images of the cervical and thoracic spine showed ventral epidural fluid collection extending from C6 to T10 (yellow arrows) and disc-osteophyte complex at the C6-7 disc level (green arrow).
See this image and copyright information in PMC

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