Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.
Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
Does your child have any gait abnormalities such as ataxia? Ataxia is a symptom of 100s of neurologic diseases and can be attributed to the cerebellum (e.g., in adults, chronic alcoholism can cause cerebellar atrophy).
In general, ataxias could be divided into a few groups. Since you mentioned atrophy, it may be a neurodegenerative process or due to an inborn error metabolism and/or a genetic defect that disrupts metabolism in cerebellar cells.
For the inborn errors of metabolism, some treatable examples include betalipoproteinemia, adrenomyeloneuropathy, cerebrotendinous xanthomatosis, familial vitamin E deficiency, maple syrup urine disease, pyruvate dehydrogenase deficiency, Refsum disease, and Wilson disease. Certain features in the history and physical examination will suggest these disorders, because they are most often associated with other abnormalities. Many of these disorders begin in childhood or adolescence/young adult-hood. Management typically relies on dietary modification, vitamin/cofactor supplementation, or drugs to reduce the load of the accumulating toxic metabolite, or removal of abnormal proteins from the blood by a procedure called plasmapharesis.
Other types of cerebellar ataxias that are genetic such as the large group of genetic disorders called "spino-cerebellar ataxias", Ataxia-telangiectasia, Friedreich ataxia, and other mitochondrial disorders are being studied, certain modifications may be helpful but there is not a cure. These have specific features that suggest one type versus another and genetic testing is available for some of them.
I would suggest that your child be evaluated by a pediatric neurologist so that the MRI can be reviewed in the context of your child's clinical examination.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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