Progression and management of superficial siderosis

Isolated cognitive dysfunction in the presence of superficial siderosis after meningioma resection at the cervicothoracic junction

Superficial siderosis is a rare disorder characterised by the deposition of haemosiderin on the surface of the central nervous system. Cognitive dysfunction has sporadically been reported in relation with superficial siderosis. We present a 61-year-old man with cognitive dysfunction in the presence of the typical radiological image of temporal and cerebellar superficial siderosis, most likely due to pseudomeningocoele 14 years after resection of a meningioma at the cervicothoracic junction. Xantochromia was present on cerebrospinal fluid investigation and a source of bleeding was seen during surgical exploration. Despite surgical treatment of the suspected bleeding source, the patient deteriorated and neuropsychological examination 1 year after surgery showed progression of cognitive dysfunction to dementia. It is likely that in the absence of other typical symptoms such as cerebellar ataxia and hearing loss, the cognitive dysfunction was not related to the superficial siderosis.

Case Report: A Comprehensive Neuropsychological Assessment of a Case of Superficial Siderosis

Objective

Superficial siderosis (SS) is a neurodegenerative condition due to the long-term effects of hemosiderin deposition on the surface of the brain, cerebellum, brainstem, and spinal cord. SS symptoms include sensorineural hearing loss, ataxia and upper motor neuron signs. SS was diagnostically evasive until magnetic resonance imaging (MRI) became available. As the detection of SS improved, case studies have become more prevalent. To our knowledge, however, this is the first report of SS detailing a comprehensive neuropsychological assessment.

Method

The current study presents a right-handed female in her early 60s, with a university level of education, who was diagnosed with SS.

Results

Her neuropsychological profile showed impairment across multiple domains, including memory and executive function, with consistent behavioral findings. The results from a comprehensive neuropsychological assessment include dementia and a cerebellar cognitive affective syndrome.

Conclusions

Neuropsychological evaluation of a patient with new cognitive impairment in combination with unexplained hearing loss, gait disorder, or myelopathy should lead to a referral for MRI that includes techniques sensitive for iron deposition, in order to rule out SS.