Multiple system atrophy (MSA-C)

Case contributed by A.Prof Frank Gaillard

Presentation

3 years of autonomic dysfunction (labile BP, bladder dysfunction) parkinsonism and cerebellar signs.

Patient Data

Age: 75
Gender: Female
MRI

Multiple FLAIR hyperintensities are seen throughout the supratentorial brain, confluent around the lateral ventricles. The SWI sequence shows innumerable punctate foci of previous haemorrhage in both the supra- and infratentorial brain, more pronounced in the basal ganglia and pons.

No abnormal diffusion restriction is seen. Atrophy of the brainstem and cerebellar hemispheres is more pronounced than that affecting the supratentorial brain; there is a "hot cross bun sign". MR Perfusion suggests generalised decreased cerebral blood flow, with possibly only relative sparing of the right peri-Sylvian region.

Conclusion:

1. Features of multiple system atrophy

2. Multiple cerebral microhaemorrhage are predominantly in the basal ganglia and pons, and thus more likely related to hypertension rather than amyloid angiopathy.

PlayAdd to Share

Case information

rID: 28425
Case created: 25th Mar 2014
Last edited: 28th Oct 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.