Presentation
Progressive dysphasia and bulbar symptoms including dysphagia and dysphonia. Associated recent history of falls and urinary incontinence.
Patient Data
Age: 65 years
Gender: Female
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Largely unremarkable although there is relatively prominent loss of volume in the posterior fossa, and some high signal crossing the pons best seen on FLAIR.
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The degree of atrophy has significantly progressed, seen both on midline sagittal and more easily on axial image. A hot cross bun sign is now evident on FLAIR.
Case Discussion
Multiple system atrophy can divided clinically into 2 forms:
- MSA-C : predominance of cerebellar symptoms (olivopontocerebellar atrophy)
- MSA-P : predominance of parkinsonian signs and symptoms (striatonigral degeneration)
This case is the former (MSA-C) and striking cerebellar changes are evident.
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