Multiple system atrophy - cerebellar type (MSA-C)
Tremors, dysdidokokinesia, gait instability and dysarthria for two years. Clinically suspected parkinson variant.
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Significant cerebellar atrophy with the "hot cross bun" sign in the midbrain. Sagittal images demonstrating the the midbrain is not atrophic.
MSA presents as a variable combination of parkinsonism, cerebellar ataxia and/or autonomic failure such as orthostatic hypotension. Striatonigral degeneration (SND) is now known as MSA-P, olivopontocerebellar atrophy (OPCA) is now known as MSA-C. Both MSA-P and MSA-C may have variable components of SDS.
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