"Hot cross bun" sign in two patients with multiple system atrophy-cerebellar.

The “hot cross bun” sign is characterized by cross-shaped T2 signal hyperintensity within the pons and has been said to be specific although not pathognomonic for multiple system atrophy (MSA).1 Case 1 is a 60-year-old woman who presented with progressive spasticity, limb ataxia, and urinary incontinence of 3 1⁄2 years’ duration (figure 1). Case 2 is a 56-year-old man, who had a history of urge incontinence of urine and stool with scanning speech and limb ataxia (figure 2). On examination both patients had cerebellar signs, brisk tendon jerks, and cogwheel rigidity. Patients were diagnosed as probable MSA (MSA-cerebellar).2