Presentation
Cerebellar static and kinetic syndrome.
Patient Data
There is diffuse brainstem volume loss throughout all its sections, as well as in the middle cerebellar peduncles.
Moderate atrophy of the vermis and cerebellar hemispheres is observed, accompanied by widening of the sulci and pericerebellar fluid spaces.
In T2, T2* and FLAIR images there are characteristic perpendicular hyperintense bands in the pons, realising the classic "hot cross bun sign"
A right fronto-parietal subdural fluid collection is present, with a signal comparable to CSF without mass effect (hygroma).
There is sequelae of a contusion probably due to an anterior trauma.
Case Discussion
Clinical presentation and MRI findings conclude with the diagnosis of multiple system atrophy (MSA-c type)
Multiple system atrophy (MSA) is a sporadic neurodegenerative disease and synucleinopathy characterised by varying degrees of cerebellar ataxia, autonomic dysfunction, parkinsonism, and corticospinal dysfunction.
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