Teaching neuroImages: MRI changes in superficial siderosis.

A 41-year-old woman presented with 2 months of dysarthria. Her history included 6 years of unsteadiness resulting in multiple falls and 10 years of intermittent urinary incontinence. She had a history of significant trauma including having been knocked over by a horse and being involved in 2 car accidents, 1 resulting in loss of consciousness and amnesia. On examination, she had finger-nose dysmetria and an ataxic gait. She had normal strength but upgoing plantar reflexes. There was no sensorineural hearing loss. Brain MRI (figures 1 and 2) showed hemosiderin deposition consistent with a diagnosis of superficial siderosis.1,2