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A 74-year-old man presented with a 2-year history of gait ataxia, bilateral sensorineural hearing loss, cognitive impairment, vertigo, falls and urinary retention. His mobility had worsened, with several falls over 3 months. Two and half years before, he had been thrown from his quad bike while 3 000 feet up a mountain, hitting his head without a helmet. He had also sustained multiple mild traumatic brain injuries in childhood and adolescence due to fights, horseback riding and skiing. On neurological examination, there was bilateral deafness, left pronator drift and mild weakness throughout all four limbs (4/5 MRC). Deep tendon reflexes were symmetric and brisk throughout (3+) and cerebellar testing showed left upper arm dysmetria.
MR scan of brain with susceptibility-weighted imaging (figure 1A) and T2-weighted imaging (figure 1B) showed superficial siderosis involving the Sylvian fissures, brainstem structures, cerebellar sulci and surrounding the third and lateral ventricles. MR …
Contributors All authors were directly involved in the patient’s care and management. NN drafted the original manuscript. NN and KM came up with the case writeup and were involved in the patient’s care from neurology. SN and JR interpreted neuroimaging studies. EG, HB and AN were involved in the patient’s case from neurosurgery. All authors provided intellectual content for the manuscript and edited the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None to declare.
Patient consent for publication Consent obtained from next of kin.
Provenance and peer review Not commissioned. Externally peer reviewed by Brendan Mclean, Truro, UK.