0:01

This is an elderly patient who

0:03

is being evaluated for ataxia.

0:08

On the sagittal T2-weighted scan, you see

0:11

what is likely to represent DISH, that is

0:13

Diffuse Idiopathic Skeletal Hyperostosis,

0:16

with large flowing osteophytes anteriorly

0:20

with relative sparing of the disc spaces.

0:24

However, the finding on the spinal cord

0:28

evaluation is a relative decrease in

0:32

the overall caliber of the spinal cord.

0:36

If we look at the spinal cord on axial scans,

0:40

again, we're a little bit impressed with relative

0:43

decrease in the caliber of the spinal cord

0:51

in its AP width.

0:53

Normally, we say that the spinal cord

0:55

should represent greater than 50%

0:57

of the overall thecal sac diameter,

1:01

and this one is borderline low.

1:07

If you look at the, um, cerebellum on this

1:12

patient, you notice that there appears

1:15

to be somewhat prominent folia of the

1:18

cerebellum, as well as the diminution in

1:23

the caliber of the spinal cord overall.

1:28

Fortunately, the patient had a

1:31

CT scan that accompanied the MRI

1:35

because of this problem with ataxia.

1:39

On the CT scan, we're impressed with the degree

1:42

of sulcal enlargement around the superior vermis

1:46

and folia of the cerebellar hemisphere,

1:49

and we contrast that with what looks like a more

1:51

normal appearance to the supratentorial cerebral

1:55

structures, in that there doesn't appear to be

1:57

that striking amount of atrophy, and certainly,

2:00

the ventricles are not particularly enlarged.

2:04

This patient has spinocerebellar ataxia.

2:09

There are multiple different varieties of spinocerebellar

2:12

ataxia, including olivopontocerebellar

2:17

degeneration, where one has a small pons,

2:22

as you see here, and middle cerebellar peduncles.

2:28

However, there are other varieties that

2:31

do not affect the pons but are purely in

2:34

the cerebellum and in the spinal cord.

2:38

In fact, there are over 15 different varieties

2:40

and they're labeled SCA2, SCA8, SCA15, and many

2:47

of these are congenital in their transmission.

2:54

This person had SCA8,

2:57

spinocerebellar ataxia, showing the

3:00

manifestations of pontine, cerebellar, and spinal

3:06

cord volume loss and the distinction among the

3:11

various SCAs cannot be generally made by imaging.