Bryan Dalton* and Shane Smyth
A 48-year old woman presented with progressive imbalance and postural dizziness for one year. She had worsening urinary incontinence for the previous four years. Her examination revealed a cerebellar ataxia with superimposed parkinsonism. She had Babinski signs and her extremities were cold and mottled. She was diagnosed with multiple system atrophy (MSA). MRI brain demonstrated a hot cross bun sign.
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