FINDINGS Figures 93-1 and 93-2. Axial T2WI and FLAIR, respectively, through the pons. There is hot cross bun sign at the pons. It is correlated with selective loss of myelinated transverse pontocerebellar fibers and neurons in the pontine raphe. There is widening of the posterior fossa CSF spaces consistent with volume loss.
DIFFERENTIAL DIAGNOSIS Parkinson-plus syndromes (progressive supranuclear palsy, corticobasal degeneration), spinocerebellar ataxia, multiple system atrophy (MSA) hereditary olivopontocerebellar atrophy.
DIAGNOSIS Multiple system atrophy (MSA)—cerebellar type.
DISCUSSION
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