Clinical-radiological correlation. Report of two cases

Area of Science:

• Neurodegenerative Disorders
• Neuroimaging
• Clinical Neurology

Background:

• Multiple system atrophy (MSA) is a rare, sporadic neurodegenerative disease.
• Clinical manifestations include parkinsonian, autonomic, cerebellar, and pyramidal signs.
• Accurate diagnosis of MSA can be challenging due to overlapping symptoms.

Observation:

• Two distinct cases of MSA are presented, highlighting varied clinical phenotypes.
• Case 1: MSA with cerebellar features (MSA-C), showing olivopontocerebellar atrophy and a pontine 'cross sign' on MRI.
• Case 2: MSA with parkinsonian features (MSA-P), demonstrating striatonigral degeneration and lenticular nucleus alterations on MRI.

Findings:

• Brain Magnetic Resonance Imaging (MRI) revealed specific characteristic signs for each MSA subtype.
• The pontine 'cross sign' was observed in MSA-C, indicative of olivopontocerebellar atrophy.
• Lenticular nucleus sign alterations were noted in MSA-P, associated with striatonigral degeneration.

Implications:

• Brain MRI findings can significantly aid in differentiating MSA subtypes.
• Neuroimaging may improve the diagnostic accuracy for Multiple System Atrophy.
• Understanding these MRI signatures is crucial for timely and precise diagnosis of MSA patients.