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“Hot cross bun” sign in a patient with parkinsonism secondary to presumed vasculitis
  1. M M K MUQIT,
  2. D MORT,
  1. Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine at Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
  1. Dr R A Shakir

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Brain MRI is an important tool in the investigation of patients with unusual parkinsonian syndromes. The “hot cross bun” sign is a radiological sign which has been said to be highly specific for multiple system atrophy.1 However, we now report on a patient with the hot cross bun sign who presented with parkinsonism secondary to presumed vasculitis.

Our patient was a 31 year old woman who was referred with an 18 month history of double vision, balance problems, and deafness. Brain MRI performed 9 months before this admission had demonstrated a non-enhancing swelling of the pons (fig 1 A). She had not responded to a 4 week course of oral adrenocorticotropic hormone treatment at that time. On admission to our unit …

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