A 58-year-old man with cerebellar ataxia Teaching NeuroImages Neurology Resident and Fellow Section © 2016 American Academy of Neurology

Presentation Progressive installation of dysarthria and bilateral deafness and cognitive impairment Neurological examination showed cerebellar ataxia and pyramidal signs Madkouri et al. © 2016 American Academy of Neurology

Imaging Madkouri et al. Figure A: Axial T2-weighted gradient echo MRI showing hemosiderin deposition in supratentorial brain (inside of sulcus), and in infratentorial brain (on the surface of the brainstem and the cerebellum). Madkouri et al. © 2016 American Academy of Neurology

Imaging Madkouri et al. Figure B: Cerebral angiography: dural arteriovenous fistula in the C1-C2 left foramen, fed by meningeal branches of the vertebral artery. Madkouri et al. © 2016 American Academy of Neurology

Superficial siderosis due to a dural cervical arteriovenous fistula The fistulous point was clipped SS of CNS is a rare disease resulting from hemosiderin deposition on the surface of the CNS and cranial nerves. At diagnosis, the etiology may not be known. Finding etiology is necessary (trauma, vascular malformation) Bibliography: 1- Koeppen AH, et al. The pathology of superficial siderosis of the central nervous system. Acta Neuropathol (Berl). 2008; 116(4):371–82. 2- Kumar N, et al. Superficial siderosis. Neurology. 2006; 66(8):1144-52. Madkouri et al. © 2016 American Academy of Neurology