PMC2939431_01
MRI imaging's showing the reported alterations. (A) Hot cross sign. (B1) cerebellar and (B2) pons atrophy. (C) Atrophy of middle cerebellum peduncles.
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fig1
In order to screen the Central Nervous System for disorders like ischemic disease, a Brain Magnetic Resonance Imaging was performed and disclosed atrophy of middle cerebellar peduncles and pons with the "hot cross bun sign" (Figure 1). Imaging findings associated with the presence of the clinical criteria like cerebellar ataxia, limb ataxia, orthostatic blood pressure decline, and stridor are compatible with Multiple-System
Vocal cords paralysis reported in endoscopy.
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fig2
Atrophy with cerebellar predominance (MSA-c). A new reasessement in Otolaryngology still disclosed vocal cords paralysis (Figure 2) and tracheostomy was kept permanently.