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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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