Presentation
Tremors, dysdiadokokinesia, gait instability and dysarthria for two years. Clinically suspected parkinson variant.
Patient Data
Significant cerebellar atrophy with the "hot cross bun" sign in the midbrain. Sagittal images demonstrate the midbrain is not atrophic.
Case Discussion
This MRI suggests possible multiple system atrophy of cerebellar type (MSA-C). Atypical Parkinson's syndromes are important to detect on imaging as they are unresponsive to levodopa.
MSA presents as a variable combination of parkinsonism, cerebellar ataxia, and/or autonomic failure such as orthostatic hypotension. Striatonigral degeneration (SND) is now known as MSA-P, olivopontocerebellar atrophy (OPCA) is now known as MSA-C. Both MSA-P and MSA-C may have variable components of SDS.
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