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...

We report a 25-year-old young man presenting with cognitive decline, pancerebellar features, spastic quadriparesis, bilateral cataract (operated) and tendo-Achilles swelling (xanthoma). The CT of the head showed bilateral cerebellar hypodensities. There were bilateral cerebellar hypointensities involving dentate nuclei on T1-weighted images with corresponding hyperintensities on T2-weighted MRI...

Progressive multifocal leukoencephalopathy (PML) remains an important complication of HIV-1/AIDS, despite widespread combined antiretroviral therapy (cART). As its name implies, it was long thought to be only a demyelinating disease restricted to brain white matter. However, JC virus (JCV), the causative agent of the classic PML form, infects glial cells and neurons, and is now known as the eti...

A 59-year-old man developed progressive gait ataxia, dysarthria, sexual dysfunction, and Raynaud phenomenon over 2 years. On examination he also manifested bradykinesia and rigidity, postural and action tremor of the upper limbs, and orthostatic hypotension. Family history was negative. Brain MRI disclosed the “hot cross bun” sign typical of multiple system atrophy (MSA) (figure).1,2 This sign ...