Ataxia that has gotten significantly worse with some dragging of the right foot and persistent strabismus. There is marked diffuse cerebellar volume loss, which has significantly progressed since 2008. Linear T2 hyperintensity in the left lateral midbrain is likely artifactual. The brainstem and supratentorial brain otherwise appear to be unremarkable. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The supratentorial ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Marked diffuse cerebellar volume loss, which has significantly progressed since 2008. Differential considerations include inherited cerebellar ataxia, mitochondrial disorders, ataxia telangectasia, for example. Perhaps MR spectroscopy can offer additional insights.