Rapidly Progressive Multiple System Atrophy-Cerebellar Type in a 52-Year-Old Woman: Diagnostic Challenges in a Resource-Limited Setting.

Multiple system atrophy (MSA) is a progressive adult-onset neurodegenerative disorder that manifests as a variable combination of cerebellar, parkinsonian, and autonomic dysfunctions. We report a case of a 52-year-old woman who presented with rapidly progressive gait ataxia, dysarthria, orthostatic hypotension, and urinary urgency. MRI of the brain demonstrated pontocerebellar atrophy with the characteristic "hot cross bun" sign, supporting a diagnosis of Multiple System Atrophy-cerebellar type (MSA-C). Despite receiving levodopa and supportive therapy, the symptoms progressed over 8 months, highlighting the unusually rapid disease course. This case highlights the diagnostic value of targeted clinical assessment and MRI when advanced confirmatory tests are inaccessible, underscoring the importance of early recognition and multidisciplinary symptom management in resource-constrained settings.