Multiple system atrophy (MSA-C)
Ataxia, spacticity, extrapyramidal symptoms
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Significant volume loss demonstrated involving the superior and middle cerebellar peduncles, with progressive flattening of the pons and medulla. Linear cruciform hyperintensity is now evident in the pons. The mid brain displays a mild reduction in volume since the prior, however not as marked as involving the pons.
There is prominence of the prepontine cistern and progressive enlargement of the fourth ventricle and cerebello-pontine angle cisterns. Mild reduction in cerebral volume with prominence of the cerebral sulci. Occasional supratentorial flair hyperintense foci reflecting chronic small vessel ischaemic change.
Atrophy of the cerebellum pons and medulla with imaging features reflecting MSA-C