Figure 3. (a,b) T1 weighted image axial MRI of brain in 1998 showing brainstem and cerebellar atrophy. Further worsening of the brainstem and cerebellar atrophy was noted in the repeat MRI study in 2002. The cerebellum is replaced by cerebrospinal fluid in the figure. The patient suffered relentless progressive deterioration despite receiving the recommended treatment. (c,d) T2 weighted image axial MR image of brain showing an increase in putaminal signal changes while on regular treatment from 1999 to 2002.