A 36-year-old man presented with spinal myoclonus, ataxia, hearing loss, an
d unilateral pupillary dilation. MRI demonstrated hemosiderin deposition al
ong the superficial surfaces of the brain, brainstem, cerebellum, and spine
. The pupillary changes were localized to the preganglionic oculomotor nerv
e. In contrast to vasculopathic oculomotor nerve palsies, superficial sider
osis may cause selective involvement of the superficially located pupillary
fibers.