Superficial siderosis of the central nervous system

The term superficial siderosis is used to describe the haemosiderin deposition on the surface of the brain, spinal cord, brainstem and cranial nerve leptomeninges following recurrent subarachnoid haemorrhage. The concern is the cytotoxic nature of the haemosiderin on the underlying tissue causing slow but progressive and irreversible neurological dysfunction. Removal of the source of bleeding has little effect on the progression of clinical deterioration but halting the chronic subarachoid haemorrhage will reduce the iron load in the CSF and hence the cytotoxic risk. We present a case of superficial siderosis presenting with hearing loss and cerebellar signs highlighting the imaging findings.