Also noted was a long-segment, nonenhancing, extra-arachnoid fluid collection along the ventral aspect of the thecal sac, extending from C 6 to the D 12 spinal levels, with minimal mass effect on the thecal sac. There was long-segment spinal cord T2 signal abnormality, which extended from the medulla to the D 2 spinal segment, with no cord expansion. Typical findings of superficial siderosis (SS) were seen in the brain and the spinal cord on MRI. Cerebrospinal fluid (CSF) and cytological analyses revealed xanthochromia and hemosiderin-laden macrophages. In addition, he had bilateral asymmetric high-frequency sensorineural hearing loss. He had decreased vibration sensation and proprioception in the lower extremities, walked with a wide-based gait, and had a positive Romberg test. Physical examination revealed bilateral lower limb dysmetria, with exaggerated lower limb deep tendon reflexes and Babinski sign bilaterally. A 56-year-old presented with a two-year history of progressive bilateral weakness, incoordination of the lower extremities, and progressive hearing loss.
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