Clinical History:
A 49 years old male presented with over 2 years history of:
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- Difficulty in moving eyes and lack of control over the eyes.
- Stiffness in both upper and lower limbs.
- Difficult speech and swallowing.
- Mild dementia.
- No h/o past vascular insult/stroke.
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- The mid-sagittal T1WI shows that the rostral midbrain tegmentum appears small in size with a concave profile (instead of normal convex profile).
- Pons appears normal.
- Mild dilatation of the third ventricle is noted.
- Increased signal intensity is noted in the periaqueductal gray matter on T2WI and FLAIR sequences.