Midbrain meningioma causing subacute parkinsonism

Multiple system atrophy (MSA) is an adult-onset sporadic neurodegenerative disorder characterized by any combination of parkinsonism, cerebellar ataxia, autonomic failure, and pyramidal tract signs.1 Structural brain MRI shows atrophy of the putamen, middle cerebellar peduncle, and pons.1 Although MSA is a rapid progressive disorder with no effective treatment, and it can present with a wider range of clinical features, several neurologic disorders underlying diverse etiologies can be clinically misdiagnosed as MSA and vice versa. Here we present a patient with subacute onset of neurologic symptoms resembling atypical parkinsonism similar to MSA due to a clival meningioma of the posterior fossae.