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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 56, Num. 2, 2008, pp. 218-218

Neurology India, Vol. 56, No. 2, April-June, 2008, pp. 218

Letter To Editor

Hot cross bun sign

Suresh Chandran CJ, Godge YR, Oak PJ, Ravat SH

Department of Neurology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
Correspondence Address:Department of Neurology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra

Code Number: ni08065


A 60-year-old man presented with progressive spasticity, limb ataxia, scanning speech and urinary incontinence of three years duration. On examination he had orthostatic hypotension (systolic fall of 22 mmHg and diastolic fall of 10 mmHg), bilateral cerebellar signs, brisk deep tendon jerks, bilateral extensor plantars and cogwheel rigidity. Patient was diagnosed as probable Multiple System Atrophy (MSA-cerebellar). [1] Magnetic resonance imaging of the brain showed "hot cross bun" sign [Figure - 1],[Figure - 2]. The hot cross bun" sign is characterized by cruciform T2 signal hyperintensity within the pons and has been said to be specific although not pathognomonic for multiple system atrophy (MSA). [2] Pontocerebellar degeneration results in lateral as well as longitudinal pontine fibers becoming evident as high signal on T2, manifesting as "hot cross bun" sign. There is significant correlation between atrophies of pontine base and existence of the cross sign in patients of multiple system atrophy. All patients with a smaller area of pontine base (two standard deviations below those of normal controls) have the cross sign. [3]


1.Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ, et al . Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 1999;163:94-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Burk K, Skalej M, Dichgans J. Pontine MRI hyperintensities ("the cross sign") are not pathognomonic for multiple system atrophy (MSA). Mov Disord 2001;16:535.  Back to cited text no. 2    
3.Abe K, Hikita T, Yokoe M, Mihara M, Sakoda S. The "Cross" signs in patients with multiple system atrophy: A quantitative study. J Neuroimaging 2006;16:73-7.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

Copyright 2008 - Neurology India

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