The entire spectrum of typical and atypical magnetic resonance imaging changes in a single case of Wilson’s disease

Neuroimage: "Hot Cross Bun"? Sign (Reverse) in Case of Wilson Diseases

“…Midbrain involvement occurs in 40% cases of brainstem with radiological signs such as "Face of giant panda sign" which is characterised by hyper intensities involving tegmentum with intact red nucleus and lateral part of substantial nigra and "CPM-like changes" with three distinct patterns for Wilson's disease: (1) the most common pattern of round shape, (2) bisected, and (3) trisected or "trident" sign occasionally reported in pons. However, all MRI features have rarely been reported in single patient but "Hot cross bun" sign (reverse) has never been reported in earlier literature of Wilson disease [1]. It has been described multisystem atrophy, spinocerebellar ataxia; cerebrotendinous xanthomatosis and pontine infarct (reverse) [2].…”