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The hot cross bun sign in a patient with encephalitis

Yingyan Gan1, Huici Liang1, Xiaojing Li1

  • 1Guangzhou Women and Children's Medical Center, Department of Pediatric Neurology, China.

Brain & Development
|February 19, 2018
PubMed

Insights

The hot cross bun (HCB) sign on MRI, typically seen in neurodegenerative diseases, was observed in a child with encephalitis. Immunosuppressive treatment led to HCB sign resolution, suggesting its potential as a reversible imaging marker.

Area of Science:

  • Neurology
  • Radiology
  • Pediatric Neurology

Background:

  • The 'hot cross' bun (HCB) sign is characterized by pontine cruciform hyperintensity on T2-weighted MRI.
  • This imaging finding is commonly associated with neurodegenerative conditions like multiple system atrophy and spinocerebellar ataxias.

Observation:

  • A 3-year-old boy diagnosed with encephalitis presented with the HCB sign on his pontine MRI.
  • This case highlights a potential non-degenerative cause for the HCB sign.

Findings:

  • Following immunosuppressive therapy, the patient showed significant clinical improvement over a 14-month follow-up period.
  • Serial MRI scans revealed a marked narrowing and near disappearance of the HCB sign.

Implications:

  • The resolution of the HCB sign suggests it can be a reversible imaging marker in certain inflammatory or infectious conditions.
  • This finding broadens the differential diagnosis for the HCB sign beyond neurodegenerative disorders.
  • Further research may elucidate the pathophysiological mechanisms underlying reversible HCB sign formation in encephalitis.
Keywords:
EncephalitisHot cross bunMRI

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