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Parkinsonian symptoms, ataxia
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Diffuse cerebellar atrophy is seen with prominence of cerebellar foliae.
Atrophy of bilateral middle cerebellar peduncles is also seen. Hypointensity is seen in posterolateral putamen on T2wt and gradient images.
Subtle cruciform hyperintensity is seen in pons on FLAIR.
Focal lacunar infarcts and areas of ischemic demyelination seen in bilateral
subcortical white matter.
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.