Multisystem Atrophy

Findings:

Multiple MR images demonstrate marked atrophy of the pons and severe cerebellar atrophy. Significant supratentorial signal abnormality or atrophy is not included. Perpendicular bandlike signal abnormalities are present within the central pons.

Differential Diagnosis/Discussion:

The presence of marked asymmetric brainstem atrophy and cerebellar atrophy in the absence of supratentorial atrophy indicates an underlying neurodegenerative process. The cruciform T2 hyperintensity of the central pons is characteristic for MSA. Cerebello-olivary atrophy would be expected to have more selective lateral cerebellar atrophy, and spinocerebellar (Friedrich) ataxia would be expected to have more posterior spinal cord atrophy. Other causes of cerebellar atrophy more commonly involve the cerebellum more asymmetrically than the brainstem.

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