This patient presented with bilateral sensorineural hearing loss and dizziness. The axial T2-weighted MR image above shows signal loss over the cerebellar folia, a characteristic finding in leptomeningeal (a.k.a. superficial) haemosiderosis.

Leptomeningeal haemosiderosis typically presents with hearing loss and vestibular dysfunction as the vestibulocochlear nerve is particularly sensitive to it. Presentation may be with other cranial neuropathies, or cerebellar dysfunction. The condition may also be asymptomatic. The aetiology is considered to be repeated subarachnoid haemorrhages, and a search for a source is indicated. This should include spinal MR. Amyloid angiopathy has been described as a cause.

Reference: Linna J, et al. Subarachnoid hemosiderosis and superficial cortical hemosiderosis in cerebral amyloid angiopathy. AJNR 2008;29:184-186
Credit: Dr Laughlin Dawes