We have the following linear matrix equation in $\mathrm X$
$$\mathrm X \mathrm A - \mathrm A \mathrm X + \mathrm N^{\top} \mathrm X \mathrm N + \mathrm Q = \mathrm O_n$$
where all the matrices are real and $n \times n$. Matrices $\mathrm A$ and $\mathrm N$ are skew-symmetric. Multiplying both sides by $-1$, we rewrite the matrix equation as follows
$$\mathrm A \mathrm X - \mathrm X \mathrm A - \mathrm N^{\top} \mathrm X \mathrm N = \mathrm Q$$
Exploiting the skew-symmetry of $\mathrm A$ and $\mathrm N$, we obtain
$$\mathrm A \mathrm X + \mathrm X \mathrm A^{\top} - \mathrm N \mathrm X \mathrm N^{\top} = \mathrm Q$$
Vectorizing both sides, we obtain a linear system of $n^2$ equations in $n^2$ unknowns
$$\underbrace{\left( (\mathrm I_n \otimes \mathrm A) + (\mathrm A \otimes \mathrm I_n) - (\mathrm N \otimes \mathrm N) \right)}_{=: \mathrm M} \, \mbox{vec} (\mathrm X) = \mbox{vec} (\mathrm Q)$$
If $\mathrm M$ has full rank, then the linear matrix equation has only one solution, which may or may not be positive definite. If $\mathrm M$ does not have full rank and the linear system is
- consistent, then the linear matrix equation has infinitely many solutions, and we can look for one that is positive definite. This is the most interesting case.
- inconsistent, then the linear matrix equation has no solution.
Let $\mathrm C_i \in \mathbb R^{n \times n}$ be the "un-vectorization" of the $i$-th row of matrix $\mathrm M$. We then have $n^2$ equations
$$\langle \mathrm C_i, \mathrm X \rangle = \langle \mathrm e_i, \mbox{vec} (\mathrm Q) \rangle$$
each defining an affine space in $\mathbb R^{n \times n}$. Relaxing the positive definiteness constraint $\mathrm X \succ \mathrm O_n$ and imposing the positive semidefiniteness constraint $\mathrm X \succeq \mathrm O_n$ instead, we have the intersection of $n^2$ affine spaces with the positive semidefinite cone, i.e., we have a (closed) spectrahedron.
If this spectrahedron has no interior (i.e., if it is "flat"), then there is no positive definite solution to the given linear matrix equation.
If this spectrahedron has an interior, then there are infinitely many positive definite solutions to the given linear matrix equation. Note that there can be no unique positive definite solution.
We can attempt to find one of the positive definite solutions by solving the following semidefinite program (SDP)
$$\begin{array}{ll} \text{minimize} & \langle \mathrm O_n, \mathrm X \rangle\\ \text{subject to} & \langle \mathrm C_1, \mathrm X \rangle \,\,= q_{11}\\ & \langle \mathrm C_2, \mathrm X \rangle \,\,= q_{21}\\ & \quad\quad\quad \vdots\\ & \langle \mathrm C_{n^2}, \mathrm X \rangle = q_{nn}\\ & \mathrm X \succeq \mathrm O_n\end{array}$$
where $q_{ij}$ is the $(i,j)$-th entry of $\mathrm Q$. The objective function is zero because we would like to find a solution in the interior of the spectrahedron, not on its boundary (where it would only be positive semidefinite). If the SDP is infeasible, then there are neither positive semidefinite nor positive definite solutions.