An otherwise healthy middle-aged woman was experiencing gait instability. Neurological examination revealed truncal ataxia. Family history was negative. Brain and spinal cord 1.5-T magnetic resonance imaging (MRI) was performed and yielded normal results. Thyroid hormone, vitamin B12, and folic acid levels were normal. During the next 4 years, her walking difficulties progressed. She also developed palatal tremor. Repeated brain MRI revealed T2 hyperintensities in both olivary nuclei. Therefore, she was referred to our institution for further evaluation.
Axial (A) and coronal (B) views of 3-T, T2-weighted brain magnetic resonance imaging showing hyperintensities of the olivary nuclei (arrows).
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