MSA hot cross buns sign

Multi-systems atrophy is a progressive neurodegenerative disorder often initially difficult to differentiate from Parkinson’s Disease. Patients present with autonomic instability (fainting due to orthostasis, fluctuating heart rate, urinary incontinence or difficulty emptying bladder) and movement disorders (tremor, rigidity, ataxia).

MSA is further classified into cerebellar predominant (MSA-C) or Parkinsonian predominant (MSA-P) depending on the primary symptom constellation.

One radiographic sign that is helpfu in diagnosing MSA is a “hot-crossed buns” appearance in the pons. Thought to be due to selective loss of ponto-cerebellar fibers, the sign consists of T2 hyperintensity that divides the pons into quadrants. The example shown below is from a patient with MSA-C (red lines point to the abnormal hyperintensities crossing the pons).


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About the Author: Naoum P. Issa MD PhD