“Hot Cross Bun” Sign in Variant Creutzfeldt-Jakob Disease

A, Axial diffusion-weighted image shows symmetric striatal and thalamic atrophy and widespread cortical high signal intensity. Apparent diffusion coefficient maps (not shown) revealed corresponding decreased cortical signal intensity, confirming restricted water diffusion. B, Axial fluid-attenuated inversion recovery image demonstrates pontine “hot cross bun” sign, atrophic and hyperintense middle cerebellar peduncles, global cerebellar atrophy, and cortical temporal lobe high signal intensity.