45yrs female with c/o generalised body weakness and slurring of speech for 1 yr.
Diffuse cerebellar and brainstem atrophy( flattening of ventral pons) including cerebellar peduncles resultant enlargement of fourth ventricle and adjacent subarachnoid spaces including prepontine cistern…Hot cross bun sign seen
Ddx - MSA - C type, pontocerebellar hypoplasia and spinocerebellar ataxia