The hot cross bun sign is seen on transverse T2-weighted magnetic resonance images of the brain as a cruciform hyperintensity in the pons This appearance is seen in patients with MSA-c. The sign is due to a selective loss of myelinated transverse pontocerebellar fibers and neurons in the pontine raphe with preservation of the pontine tegmentum and corticospinal tracts. Note in our case of 47 year old female, cruciform hyperintensity in pons, cerebellar atrophy and high signal in the middle cerebellar peduncles, possibly MSA-c.
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