Multiple system atrophy

  • Sporadic progressive neurodegenerative disorder
  • Adulthood onset
  • Glial cytoplasmic inclusions containing alpha synuclein
  • Combination of cerebellar, autonomic, extra-pyramidal and pyramidal signs
  • MSA-P: predominant parkinsonian features
  • MSA-C: predominant cerebellar dysfunction
  • MSA-C: reduced pontine volume. Cerebellar atrophy. Cruciform T2 pontine hyperintensity (hot cross bun sign)
  • MSA-P: also shows excess mineralization of bilateral putamina and substantia nigra