0:00

This 75-year-old woman,

0:02

has gaze palsy and gait disturbance.

0:05

She was carried as a Parkinson's syndrome patient,

0:09

but she does not have classic Parkinson's disease.

0:12

Look at the preservation of Arizona compactus

0:14

stripe between the red nucleus

0:17

and the substantia nigra

0:19

and the dopaminergic stripe

0:21

or hypointensity more anteriorly.

0:24

When looking sagittally,

0:25

we see atrophy of the superior colliculus

0:28

and the patient manifests the hummingbird sign.

0:31

So, so far you've heard about the hummingbird sign

0:34

in the axial projection.

0:35

You heard how this area may become atrophic and

0:38

convex inward,

0:39

producing the morning glory sign.

0:41

You've heard about the Mickey Mouse sign,

0:44

you've heard about secondary causes of PSP that

0:47

may be created from other disorders

0:50

like Creutzfeldt-Jakob disease or CJD

0:53

with a hockey stick sign or the pulvinar sign.

0:57

And I want to clear one thing up,

0:59

the hot cross bun sign.

1:03

No, the buns are not here.

1:04

That does look like somebody's buns,

1:07

but not the kind of buns that I'm talking about.

1:09

I'm talking about the kind of buns that you would

1:10

eat at the bakery.

1:12

Down in the pons, down here.

1:15

So the buns are a little bit tighter here,

1:18

if you know what I mean.

1:19

And when things are very atrophic,

1:22

these buns will really stick out

1:24

and become more conspicuous.

1:26

So, this hot cross bun sign is evidence of pontine

1:30

atrophy as opposed to midbrain atrophy.

1:34

So, we're going to be down lower at the level

1:36

of the middle cerebellar peduncle,

1:39

the brachium conjunctivum,

1:40

and here's a little bit more of the

1:43

brachium conjunctivum right here.

1:45

So, where do you see the hot cross bun sign?

1:48

The last sign that we'll discuss.

1:49

You see that classically

1:51

in multisystem atrophy or MSA.

1:54

Now, you can also see it in a few other conditions,

1:57

spinocerebellar atrophy types two and three,

2:00

secondary Parkinson's syndrome from vasculitis,

2:04

variant CJD or Creutzfeldt-Jakob disease,

2:08

and also something called JC virus,

2:10

granule cell neuropathy.

2:13

So, now you know all the signs that you're going

2:16

to see around the midbrain area

2:18

and around the thalamus.

2:19

I've listed them all off for you.

2:22

The morning glory sign,

2:23

the hummingbird sign,

2:25

the Mickey Mouse sign,

2:27

the pulvinar sign,

2:28

the hockey stick sign,

2:30

and now, for MSA,

2:32

as the classic, the hot cross bun sign,

2:36

which you will see in MSA.