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LETTER TO EDITOR
Year : 2008  |  Volume : 56  |  Issue : 2  |  Page : 218

Hot cross bun sign


Department of Neurology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India

Correspondence Address:
C J Suresh Chandran
Department of Neurology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.42015

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How to cite this article:
Suresh Chandran C J, Godge Y R, Oak P J, Ravat S H. Hot cross bun sign. Neurol India 2008;56:218

How to cite this URL:
Suresh Chandran C J, Godge Y R, Oak P J, Ravat S H. Hot cross bun sign. Neurol India [serial online] 2008 [cited 2020 Feb 23];56:218. Available from: http://www.neurologyindia.com/text.asp?2008/56/2/218/42015


Sir,

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]

 
  References Top

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]


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