Multiple system atrophy

Case contributed by Assoc Prof Frank Gaillard


Progressive dysphasia and bulbar symptoms including dysphagia and dysphonia. Associated recent history of falls and urinary incontinence.

Patient Data

Age: 65 years
Gender: Female

MRI brain

MRI of the brain is 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. 


MRI brain - 6 months later

Only 6 months later and 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: 

  1. MSA-C : predominance of cerebellar symptoms (olivopontocerebellar atrophy)
  2. 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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Case information

rID: 22188
Published: 18th Mar 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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