ELOVL4 and spinocerebellar ataxia type 34: MRI of the brain of the patient and his father, who also presented with ataxia but no skin pathology, showed pontine and cerebellar atrophy as well as the hot cross bun sign as previously reported in patients with SCA34 with p. L198F and p. W246G ELOVL4 mutations (35, 36, 65).