Multiple-system atrophy (MSA) is a progressive neurodegenerative disorder. It is characterized by dysfunction of multiple systems including autonomic, extrapyramidal, pyramidal and cerebellar. Pontine hot-cross bun (HCB) sign in MSA is a well-documented and highly specific entity. To the best of our knowledge, medullary hot-cross bun (HCB) sign has never been described in literature. Herein, we report a case of MSA-C with medullary HCB sign. Detection of medullary HCB sign might be a surrogate marker in the diagnosis of MSA-C, particularly in the absence of classical pontine HCB sign; however, further research will help to validate this sign.
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