Progressive supranuclear palsy
2 year history of increasing Parkinsonism, clinically suggestive of a Parkinson's Plus syndrome.
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Mild degree of atrophy in the posterior fossa most prominent in the midbrain, and superior colliculus suggesting a possible diagnosis of progressive supranuclear palsy. The basal ganglia are normal. No changes in the putamen that are usually associated with MSA - P. No changes in the pons to suggest MSA - C. No abnormal iron accumulation noted.
Dilated lateral, 3rd and 4th ventricles with prominent bilateral Sylvian fissures. Small subependymal cyst noted along the right frontal horn. No definite transependymal oedema demonstrated. The aqueduct is patent with prominent CSF flow void. Quantitative measurements of flow are within normal range (not shown). No downward bowing of the floor of the third ventricle.
There are at least 3 oval high FLAIR signal foci in the left periventricular region. No intracranial mass. No abnormal diffusion restriction.
Midbrain to pons ratio: 0.15
Findings are most in keeping with PSP.
The clinical picture in this case was consistent with progressive supranuclear palsy (PSP), and imaging was supportive of this diagnosis.