Multiple system atrophy

Case contributed by Dr Chee Kok Yoon


55 year old Malay woman presented with 2 year history of rapidly progressing dementia, parkinsonian features, and later pyramidal signs. Cerebellar involvement with ataxia and broad-base gait. No autonomic instability and unsure of any new incontinence (already with continence aids). She was sensitive to dopamine agonist and low dose atypical antipsychotics. Currently bed bound.

Patient Data

Age: 55
Gender: Female

There is atrophy of the pons with a cruciform T2 hyperintensity in keeping with the hot cross bun sign.

Case Discussion

In most cases, provided the patient has been referred appropriately, the diagnosis of MSA-C is already suspected by the time such prominent pontine changes are seen. 

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Case information

rID: 19577
Published: 26th Sep 2012
Last edited: 11th Sep 2018
Inclusion in quiz mode: Included

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