An Insidious Complication of Spontaneous Spinal CSF Leak: Superficial Siderosis

Superficial siderosis of the CNS can result in long-term morbidity for patients with spontaneous intracranial hypotension, even after successful treatment of the causative spinal CSF leak. Spontaneous spinal CSF leaks are categorized by causative mechanisms, which include dural tears, meningeal diverticula, and CSF-venous fistulas. Our case series demonstrates superficial siderosis preferentially involving the cerebellar folia, typically resulting in symptoms of classic infratentorial superficial siderosis, and mainly occurring secondary to type 1A spinal CSF leaks.

Learning Objectives:

Superficial siderosis due to spontaneous spinal CSF leaks preferentially involves the cerebellar folia.

Symptoms are typically those of classic infratentorial superficial siderosis, consisting of hearing and vestibular impairment, gait ataxia, myelopathy and/or cognitive dysfunction.

Superficial siderosis typically occurs in setting of type 1A spinal CSF leaks (ventral dural tears).