Teaching NeuroImage: MRI in multiple system atrophy “Hot cross bun” sign and hyperintense rim bordering the putamina

A 59-year-old man developed progressive gait ataxia, dysarthria, sexual dysfunction, and Raynaud phenomenon over 2 years. On examination he also manifested bradykinesia and rigidity, postural and action tremor of the upper limbs, and orthostatic hypotension. Family history was negative. Brain MRI …