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Prevalence of the Hot Cross Bun Sign and Factors Associated With HCBS Positivity in Patients With Multiple System Atrophy.

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Title: Prevalence of the Hot Cross Bun Sign and Factors Associated With HCBS Positivity in Patients With Multiple System Atrophy.
Authors: Zhang, Kaige (AUTHOR), Wang, Yao (AUTHOR), Xu, Xuan (AUTHOR), Zhang, Han (AUTHOR), Wang, Yunxian (AUTHOR), Wei, Meiqi (AUTHOR), Chen, Zhigang (AUTHOR), Saleem, Suraiya (AUTHOR)
Source: Acta Neurologica Scandinavica. 5/25/2026, Vol. 2026, p1-9. 9p.
Subjects: Multiple system atrophy, Disease risk factors, Parasomnias, Brain imaging, Disease progression, White matter (Nerve tissue)
Abstract: Objective: In patients with multiple system atrophy (MSA), the hot cross bun sign (HCBS) has been associated with disease severity in MSA. This study is aimed at investigating the prevalence of HCBS and its potential risk factors in Chinese MSA patients. Materials and Methods: A total of 175 MSA patients who met "possible" or "probable" diagnostic criteria were included in this cross‐sectional study. The Unified MSA Rating Scale (UMSARS), Nonmotor Symptoms Scale (NMSS), Hamilton Depression Rating Scale‐17 (HDRS‐17), Hamilton Anxiety Scale (HAMA), and Montreal Cognitive Assessment (MoCA, permission has been granted) were compared between MSA patients with and without HCBS (defined as pontine cruciform hyperintensity on T2‐weighted fluid‐attenuated inversion recovery [T2‐FLAIR] sequences). Binary logistic regression analysis was used to identify the independent risk factors for the presence of HCBS. Results: HCBS was identified in 110 of 175 patients (62.86%). Univariate analysis revealed significant relationships between HCBS and female, cerebellar subtype, REM sleep behavior disorder (RBD), higher UMSARS‐IV score, and moderate‐to‐severe white matter hyperintensities (WMHs). The occurrence of HCBS in MSA was independently associated with the MSA‐C subtype (OR = 6.05, 95%CI = 2.55–14.38), RBD (OR = 2.56, 95%CI = 1.06–6.20), higher UMSARS‐IV scores (OR = 2.48, 95%CI = 1.42–4.35), and moderate‐to‐severe WMH (OR = 4.10, 95%CI = 1.14–14.75). Conclusions: HCBS is a common neuroimaging observation in MSA patients. Our research shows that the MSA‐C subtype, RBD, greater disability severity (as assessed by UMSARS‐IV), and moderate‐to‐severe WMH are independent risk factors for HCBS. Higher UMSARS‐IV scores were substantially linked to the presence of HCBS, but there was no association between the severity grade of HCBS and the degree of disability. The prevalence of HCBS and its clinical correlates in a Chinese MSA cohort are demonstrated cross‐sectionally in this study, especially with regard to subtype, RBD, disability, and WMH burden. [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
  Group: Ti
  Data: Prevalence of the Hot Cross Bun Sign and Factors Associated With HCBS Positivity in Patients With Multiple System Atrophy.
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Zhang%2C+Kaige%22">Zhang, Kaige</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wang%2C+Yao%22">Wang, Yao</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Xu%2C+Xuan%22">Xu, Xuan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zhang%2C+Han%22">Zhang, Han</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wang%2C+Yunxian%22">Wang, Yunxian</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wei%2C+Meiqi%22">Wei, Meiqi</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Zhigang%22">Chen, Zhigang</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Saleem%2C+Suraiya%22">Saleem, Suraiya</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Acta+Neurologica+Scandinavica%22">Acta Neurologica Scandinavica</searchLink>. 5/25/2026, Vol. 2026, p1-9. 9p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Multiple+system+atrophy%22">Multiple system atrophy</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+risk+factors%22">Disease risk factors</searchLink><br /><searchLink fieldCode="DE" term="%22Parasomnias%22">Parasomnias</searchLink><br /><searchLink fieldCode="DE" term="%22Brain+imaging%22">Brain imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+progression%22">Disease progression</searchLink><br /><searchLink fieldCode="DE" term="%22White+matter+%28Nerve+tissue%29%22">White matter (Nerve tissue)</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: In patients with multiple system atrophy (MSA), the hot cross bun sign (HCBS) has been associated with disease severity in MSA. This study is aimed at investigating the prevalence of HCBS and its potential risk factors in Chinese MSA patients. Materials and Methods: A total of 175 MSA patients who met "possible" or "probable" diagnostic criteria were included in this cross‐sectional study. The Unified MSA Rating Scale (UMSARS), Nonmotor Symptoms Scale (NMSS), Hamilton Depression Rating Scale‐17 (HDRS‐17), Hamilton Anxiety Scale (HAMA), and Montreal Cognitive Assessment (MoCA, permission has been granted) were compared between MSA patients with and without HCBS (defined as pontine cruciform hyperintensity on T2‐weighted fluid‐attenuated inversion recovery [T2‐FLAIR] sequences). Binary logistic regression analysis was used to identify the independent risk factors for the presence of HCBS. Results: HCBS was identified in 110 of 175 patients (62.86%). Univariate analysis revealed significant relationships between HCBS and female, cerebellar subtype, REM sleep behavior disorder (RBD), higher UMSARS‐IV score, and moderate‐to‐severe white matter hyperintensities (WMHs). The occurrence of HCBS in MSA was independently associated with the MSA‐C subtype (OR = 6.05, 95%CI = 2.55–14.38), RBD (OR = 2.56, 95%CI = 1.06–6.20), higher UMSARS‐IV scores (OR = 2.48, 95%CI = 1.42–4.35), and moderate‐to‐severe WMH (OR = 4.10, 95%CI = 1.14–14.75). Conclusions: HCBS is a common neuroimaging observation in MSA patients. Our research shows that the MSA‐C subtype, RBD, greater disability severity (as assessed by UMSARS‐IV), and moderate‐to‐severe WMH are independent risk factors for HCBS. Higher UMSARS‐IV scores were substantially linked to the presence of HCBS, but there was no association between the severity grade of HCBS and the degree of disability. The prevalence of HCBS and its clinical correlates in a Chinese MSA cohort are demonstrated cross‐sectionally in this study, especially with regard to subtype, RBD, disability, and WMH burden. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1155/ane/9598542
    Languages:
      – Code: eng
        Text: English
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        PageCount: 9
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    Subjects:
      – SubjectFull: Multiple system atrophy
        Type: general
      – SubjectFull: Disease risk factors
        Type: general
      – SubjectFull: Parasomnias
        Type: general
      – SubjectFull: Brain imaging
        Type: general
      – SubjectFull: Disease progression
        Type: general
      – SubjectFull: White matter (Nerve tissue)
        Type: general
    Titles:
      – TitleFull: Prevalence of the Hot Cross Bun Sign and Factors Associated With HCBS Positivity in Patients With Multiple System Atrophy.
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            NameFull: Zhang, Kaige
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            – D: 25
              M: 05
              Text: 5/25/2026
              Type: published
              Y: 2026
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