Superficial Siderosis of the Central Nervous System due to Spinal Ependymoma

A 75-year-old woman presented with a 3-year history of progressive hearing loss, gait ataxia, and cognitive impairment. Brain magnetic resonance imaging (MRI) with a time gradient echo sequence showed deposition of hemosiderin along the surface of the cerebral cortex, brainstem, and cerebellum, as well as severe atrophy in the diffuse cerebral cortex and cerebellum. We established the diagnosis of superficial siderosis of the central nervous system on the grounds of former pathognomonic MRI findings. The thoraco-lumbar spine MRI demonstrated a myxopapillary ependymoma in the T11-L2 spinal canal that was considered to be the cause of a chronic subarachnoid hemorrhage, affecting the leptomeninges and subpial layers of the central nervous system.