Presentation
Ataxia, extrapyramidal symptoms.
Patient Data
There is a significant volume loss in the cerebellum, especially in the superior and middle cerebellar peduncles, as well as flattening of the pons and medulla. Additionally, there is mild reduction in the volume of the midbrain. T2 hyperintensity forms a cross on axial images in the pons, indicative of the 'hot cross bun' sign.
Prominence and enlargement are noted in the prepontine cistern, the fourth ventricle, and cerebellopontine angle cisterns. Mild reduction in cerebral volume is observed, along with prominence of the cerebral sulci. Occasionally, there are supratentorial flair hyperintense foci reflecting chronic small vessel ischemic changes
Case Discussion
In this case, the imaging findings and clinical signs lead us to consider multiple system atrophy (MSA-C).
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