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Superficial Siderosis of the Central Nervous System Secondary to Chronic Bleeding From a Lumbar Paraganglioma

Case Study involving dementia

A 73‐year‐old Caucasian male presented to the Hamilton
General Hospital Emergency Room with confusion, slurred
speech, lower extremity weakness and gait ataxia. According to
the patient’s family, his symptoms began five years prior to this
episode, when they noticed behavioral changes. He became aloof
and introverted. He also complained of ‘ringing’ in his ears. An
auditory examination at that time demonstrated hearing loss, for
which he started wearing hearing aids. Subsequently, there was a
progressive decline in his functional mobility and other activities
of daily living.
Upon physical examination, the patient was uncooperative.
He had a short attention span with brief moments where he
demonstrated mental competence. A Folstein mini mental status
exam revealed baseline cognitive decline most likely due to his
dementia (13/30). The cranial nerves examination demonstrated
bilateral hearing loss. He had lower extremity weakness (more
pronounced on the right than on the left), hyper‐reflexia and
Babinski sign bilaterally. No sensory deficits were noted.
Disdiadokokinesia, finger‐nose and heel‐shin dysmetria wer