Background: A 48-year-old man with a past history of a car-accident-induced coma at the age of 3 years and spontaneous bilateral subdural hematomas at the age of 34 years presented with a 2-year history of worsening gait difficulties, clumsiness and dysarthria. CT scans of the brain taken during the 6 months leading up to his presentation had revealed chronic subarachnoid hemorrhage, but angiograms had not been able to identify the source of bleeding.
Investigations: Neurological examination, brain MRI scan, lumbar puncture, four-vessel cerebral angiogram and spinal angiogram.
Diagnosis: Superficial siderosis; a complete review of the current literature on the condition is provided.
Management: Iron chelating agents.