Board Review 1 – Case 3

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

In this case, the patient has T2 hyperintensity in the pons. This abnormality takes on a cruciform shape which is known as a “hot crossed bun” appearance.

The diagnosis is: multisystem atrophy, or MSA

Multisystem atrophy is a degenerative disease which is similar to Parkinson’s disease. It does not respond well to typical Parkinson’s disease treatments. There are 3 main types of MSA.

MSA-P has Parkinsonian predominant symptoms.
MSA-C is predominated by cerebellar symptoms and ataxia
MSA-A (autonomic) is dominated by autonomic instability and was previously known as Shy-Drager syndrome