Neuroimaging: hot cross bun sign: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: hot cross bun sign

Sample item

A 62-year-old man has parkinsonism that does not respond to levodopa, early postural hypotension and cerebellar ataxia. T2 MRI of the pons shows cruciform hyperintensity. What is the likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Multiple system atrophy (cerebellar type)

Degeneration of transverse pontocerebellar fibres and the median raphe leaves a cross-shaped T2 hyperintensity in the pons, the hot cross bun sign, along with putaminal changes and cerebellar atrophy. It supports multiple system atrophy.

Option by option

  • A. Multiple system atrophy (cerebellar type) (correct)

    Correct. Pontine cruciform signal with autonomic failure and ataxia suggests MSA.

  • B. Wilson disease

    Wilson disease shows the face of the giant panda sign in the midbrain.

  • C. Progressive supranuclear palsy

    PSP shows midbrain atrophy with a hummingbird sign.

  • D. Idiopathic Parkinson disease

    Idiopathic Parkinson disease has normal structural MRI and responds to levodopa.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Multiple system atrophy (cerebellar type). Degeneration of transverse pontocerebellar fibres and the median raphe leaves a cross-shaped T2 hyperintensity in the pons, the hot cross bun sign, along with putaminal changes and cerebellar atrophy.

Why is "Wilson disease" not the answer?

Wilson disease shows the face of the giant panda sign in the midbrain.

Why is "Progressive supranuclear palsy" not the answer?

PSP shows midbrain atrophy with a hummingbird sign.

Why is "Idiopathic Parkinson disease" not the answer?

Idiopathic Parkinson disease has normal structural MRI and responds to levodopa.

What concept does this question test?

It tests Neuroimaging: hot cross bun sign in Radiology. It supports multiple system atrophy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: hot cross bun sign?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.