Figure 3.

“Hot-cross-bun” sign of multiple system atrophy (MSA) of the cerebellar-predominant subtype (MSA-C). Axial T2-weighted magnetic resonance imaging (MRI) of the brain of a 52-year-old patient four years after the onset of MSA-C shows a cruciform T2 hyperintensity in the pons called the “hot-cross-bun sign” (indicated by arrows). Cerebellum shows atrophy. Orientation is radiological. Note that this sign is not specific for MSA, as it occurs in other cerebellar degenerative disorders, such as some of the spinocerebellar ataxias.