Presentation
Ataxia.
Patient Data
prominent ventricular system and extra axial CSF spaces suggesting senile involutional changes
disproportionate cerebellar atrophy with wide cerebellar folia on both sides
no midline shift
no definite well formed territory infarction
no intra- or extra-axial areas of recent blood density
senile involutional changes with disproportionate cerebellar atrophy and prominent cerebellar folia on either side
there is also, pontine and bilateral middle cerebellar peduncle atrophy
cruciform hyperintensity is seen in pons on T2 and FLAIR sequences given the hot cross bun sign
no midline shift
mild periventricular T2/FLAIR hyperintensity with no diffusion restriction suggesting chronic small blood vessels ischaemic/gliotic changes
no definite extra axial areas of abnormal intensity
Case Discussion
The clinical history of ataxia and imaging findings (cerebellar, middle cerebellar peduncles and pontine atrophy with hot cross bun sign) suggest multiple system atrophy cerebellar type (MSA-C).
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