Presentation
Ataxia, vertigo.
Patient Data
Disproportionate cerebellar atrophy with prominence of cerebellar folia on either side. Mild atrophy of bilateral middle cerebellar peduncles is also seen.
Subtle FLAIR hyperintensity is seen in pons involving transverse pontocerebellar tracts and median pontine raphe nuclei.
Atrophy of bilateral putamina is seen with hyperintensity along their posterolateral aspects.
Focal T2/FLAIR hyperintensities are seen in bilateral periventricular and subcortical white matter, likely focal lacunar infarcts and areas of ischemic demyelination.
Bilateral convexity sulci and lateral ventricles are mildly prominent, likely age related.
Case Discussion
Imaging findings and clinical history suggest possibility of multisystem atrophy. Imaging findings overlap between type C and type P which reinstates the current belief that the subtypes are manifestation of the same disease.