Multiple system atrophy

Case contributed by Huda B. Gharbia

Presentation

Ataxia and spasticity.

Patient Data

Age: 70 years
Gender: Female
mri

Thinning of the brainstem (mainly pons and medulla oblongata) with prominence of the prepontine cistern and fourth ventricle. The hot cross bun sign is present in the pons on T2-weighted images.

Diffuse widening of folia in both cerebellar hemispheres and the vermis, and thinning of both middle cerebellar peduncles. Widened subarachnoid spaces and sulci in both cerebral hemispheres.

Case Discussion

Atrophy of cerebrum, cerebellum, and brainstem, with hot cross bun sign of the pons, suggetsive of multiple system atrophy.

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