Hot cross bun sign of pons

Case contributed by Anil Kumar Geetha Virupakshappa
Diagnosis almost certain


8 month history of deteriorating balance and coordination, associated falls and unsteady gait

Patient Data

Age: 65 years
Gender: Female

Reduced bulk of brainstem with hot cross bun sign and prominent cerebellar folia suggestive of cerebellar atrophy is noted.

Case Discussion

Multiple system atrophy cerebellar type (MSA-C), previously known as olivo-ponto-cerebellar atrophy, is associated with disproportionate atrophy of the cerebellum and brainstem with hyperintensities along pontocerebellar tracts giving a hot cross bun sign.

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