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MSA Hot Cross Bun sign

MSA Hot Cross Bun sign
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The hot cross bun sign is seen in the pons on T2-weighted or FLAIR imaging in patients with MSA-c. It occurs because myelinated transverse pontocerebellar fibers and neurons in the pontine raphe are selectively lost in this disease, while the corticospinal tracts and tegmentum are preserved. As shown in this T2 MRI, it looks like a big white plus sign in the pons.

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