Multiple system atrophy (cerebellar type, MSA-C)
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A patient presented with progressive ataxia and bilateral lower extremity spacticity.
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Significant volume loss involving both cerebellar hemispheres, middle and superior cerebellar peduncles, with atrophy and flattening of the pons and medulla. There is linear cruciform hyperintensity in the pons (hot cross bun sign), best seen on axial T2 and FLAIR images. No diffusion restriction was noted.
The supratentorial brain is unremarkable.
The findings mentioned above are most compatible with multiple system atrophy (cerebellar type, MSA-C).
Multiple system atrophy (MSA-C) is a neurogenerative disease. This case illustrates the typical findings of cerebellar type of multiple system atrophy.