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Cruciform Pontine MRI Hyperintensities (“Hot Cross Bun” Sign) in Non-Multiple System Atrophy Patients
Seong-Beom Koh, MD, Kun-Woo Park, MD, Dae-Hie Lee, MD
Journal of Movement Disorders 2008;1(2):107-108.
DOI: https://doi.org/10.14802/jmd.08022
Published online: October 30, 2008

Department of Neurology, Korea University College of Medicine, Seoul, Korea

Address for correspondence: Seong-Beom Koh, MD, PhD, Department of Neurology, Korea University College of Medicine at Guro Hospital, 80 Guro 2-dong, Guro-gu, Seoul, 152-703, Korea, Tel: +82-2-2626-1250, Fax: +82-2-2626-1255, E-mail: parkinson@korea.ac.kr
• Received: October 24, 2007   • Accepted: May 19, 2008

Copyright © 2008 The Korean Movement Disorder Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 20-year-old woman presented with a 5-year history of gait disturbance and tremor. Her mother showed the same clinical features and expired due to aspiration pneumonia at the age of 28-year-old. She was diagnosed as a spinocerebellar ataxia type 2 with molecular genetic PCR analysis. Brain T2-weighted MR image showed cruciform signal hyperintensity in pons (Figure A). A 61-year-old man presented with a 7-year history of gait disturbance after cerebellar hemorrhage. He did not showed autonomic dysfunction. Brain T2-weighted MR image showed cruciform signal hyperintensity in pons (Figure B). Cruciform pontine MRI hyperintensities (“hot cross bun” sign) is a radiologic sign which has been said to specific for multiple system atrophy.[1,2] But our patients were diagnosed as spinocerebellar ataxia type 2 and old cerebellar hemorrhage. Therefore we suggest that “hot cross bun” sign reflects degeneration of transverse pontocerebellar fibers and is not a pathognomic sign of multiple system atrophy.
Figure.
(A) Cruciform signal hyperintensities within the pons and atrophy of pons are demonstrated on the axial T2-weighted MRI of 20-year-old spinocerebellar atrophy type 2 patient with a 5-year history of ataxia. (B) Cruciform signal hyperintensities within the pons and atrophy of pons are demonstrated on the axial T2-weighted MRI of 61-year-old patient with a 7-year history of cerebellar hemorrhage.
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  • 1. Schrag A, Good CD, Miszkiel K, Morris HR, Mathias CJ, Lees AJ, et al. Differentiation of atypical parkinsonian syndromes with routine MRI. Neurology 2000;54:697–702.ArticlePubMed
  • 2. Savoiardo M, Strada L, Girotti F. Olivopontocerebellar atrophy: MR diagnosis and relationship to multiple system atrophy. Radiology 1990;174:693–696.ArticlePubMed

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    • The “Hot Cross Bun Sign” in Spinocerebellar Ataxia Types 2 and 7–Case Reports and Review of Literature
      Ansuya Kasavelu Naidoo, Cait‐Lynn Deanne Wells, Yashvir Rugbeer, Neil Naidoo
      Movement Disorders Clinical Practice.2022; 9(8): 1105.     CrossRef

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