%0 Journal Article
%A Schlapakow, Elena
%A Keil, Vera C.
%A Paus, Marie
%A Kornblum, Cornelia
%A Hattingen, Elke
%A Klockgether, Thomas
%T Multiple system atrophy mimicry in MRI: Watch out for paraneoplastic rhombencephalitis
%J Journal of clinical neuroscience
%V 76
%@ 0967-5868
%C Burlington, Mass.
%I Harcourt
%M DZNE-2020-01124
%P 238-240
%D 2020
%X The hot cross bun (HCB) sign describes cruciform-shaped T2-weighted hyperintensities of pontocerebellar fibers within the pons and is a typical, but not specific imaging hallmark of the cerebellar variant of multiple system atrophy (MSA-C). We report a case of a 51-year-old woman who was first diagnosed with MSA-C based on progressive cerebellar ataxia, the HCB sign and T2-weighted hyperintensities in middle cerebellar peduncles on MRI. However, further diagnostic work-up revealed positive anti-amphiphysin antibodies in blood and cerebrospinal fluid and subsequently breast cancer. This report of a paraneoplastic rhombencephalitis which initially mimicked MSA-C imaging features stresses the importance of considering immune-mediated rhombencephalitis as differential diagnosis in cases of progressive cerebellar ataxia and the HCB sign on T2-weighted MRI, especially in the absence of pontocerebellar atrophy.
%K Breast Neoplasms
%K Cerebellar Ataxia: diagnosis
%K Cerebellar Ataxia: diagnostic imaging
%K Cerebellar Diseases: diagnostic imaging
%K Cerebellum: diagnostic imaging
%K Diagnosis, Differential
%K Female
%K Humans
%K Magnetic Resonance Imaging
%K Male
%K Middle Aged
%K Middle Cerebellar Peduncle: diagnostic imaging
%K Multiple System Atrophy: diagnosis
%K Multiple System Atrophy: diagnostic imaging
%K Spinocerebellar Degenerations: diagnostic imaging
%F PUB:(DE-HGF)16
%9 Journal Article
%$ pmid:32307300
%R 10.1016/j.jocn.2020.04.052
%U https://pub.dzne.de/record/151540