Background: Wallerian degeneration (WD) of bilateral middle cerebellar peduncles
(MCPs) can occur following pontine infarction, but its characteristics have not yet been clarified because of the low incidence.
5 In MSA-P the degenerative changes predominantly affect the basal ganglia, particularly the putamen seen as hyperintense rim at the putaminal edge, atrophy and hypointensity of putaminal body on T2WI while in MSA-C changes predominantly affect infratentorial structures like pons and cerebellum, seen as atrophy and hyperintense signals in pons, cerebellum and middle cerebellar peduncles
with pontine hyperintensity (hot cross bun sign) on axial image,4 which was seen in both of our patient's MRI.
The radiologist reported findings that are representative of multiple sclerosis, with involvement of the right cerebral peduncle, left middle cerebellar peduncle
, medulla oblongata, anterior brainstem at the level of the pontomedullary sulcus in the region of the VI cranial nerve origins, and within the upper cervical cord.
The diagnosis of probable or possible MSA-C was established based on the second consensus criteria:[sup] (1) a sporadic, progressive, and adult (>30 years) onset disease characterized by a cerebellar syndrome (gait ataxia with cerebellar dysarthria, limb ataxia, or cerebellar oculomotor dysfunction), and (2) at least one of the additional features as follows: parkinsonism (bradykinesia and rigidity); atrophy of putamen, middle cerebellar peduncle
, or pons on magnetic resonance imaging (MRI); hypometabolism on fluorodeoxyglucose-positron emission tomography (FDG-PET) in putamen; and presynaptic nigrostriatal dopaminergic denervation on single photon emission computed tomography (SPECT) or PET.
14), and the cerebellum with the middle cerebellar peduncles
Similar lesions may also be found in the middle cerebellar peduncles
and in the hemispheric white matter involving the centrum semi ovale and extending, in some cases, into the adjacent white matter.