Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shivakumar, R.
Right arrow Articles by Thomas, S. V.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Shivakumar, R.
Right arrow Articles by Thomas, S. V.
Related Collections
Right arrow All Imaging
Right arrow MRI
Right arrow Chorea
Right arrow Basal ganglia
NEUROLOGY 2009;72:e50
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: Face of the giant panda and her cub

MRI correlates of Wilson disease

R. Shivakumar, MD and Sanjeev V. Thomas, MD

From Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Address correspondence and reprint requests to Dr. Shivakumar R, Resident, Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, India 695011 drshivakumar1995{at}yahoo.co.in

A 16-year-old girl presented with abnormal behavior and involuntary movements. Neurologic examination demonstrated Kayser-Fleischer rings, chorea, and dystonia. Serum ceruloplasmin and urine copper studies confirmed the diagnosis of Wilson disease. Brain MRI showed bilateral T2 hyperintensity involving putamen, thalami, and brainstem1 (figure, A). The midbrain "panda sign" (figure, B) is due to high signal in the tegmentum, normal signals in the red nuclei and lateral portion of the pars reticulata of the substantia nigra, and hypointensity of the superior colliculus. Dorsal pontine signal abnormalities resemble the face of a panda cub2 (figure, C).


Figure 118
View larger version (40K):
[in this window]
[in a new window]

  		Figure Brain MRI

T2-weighted axial MRI demonstrates (A) symmetric hyperintense signals in the putamen, posterior internal capsule, and thalami (arrows), (B) "face of the giant panda" in midbrain with high signal in tegmentum and normal red nuclei (arrows), and (C) "face of the panda cub" in pons with hypointensity of central tegmental tracts with hyperintensity of aqueductal opening to fourth ventricle (arrows).

 

Disclosure: The authors report no disclosures.


   REFERENCES
Top.
 REFERENCES
 

  1. Hitoshi S, Iwata M, Yoshikawa K. Mid-brain pathology of Wilson's disease: MRI analysis of three cases. J Neurol Neurosurg Psychiatry 1991;54:624–626.[Abstract/Free Full Text]
  2. Jacobs DA, Markowitz CE, Liebeskind DS, Galetta SL. The double panda sign in Wilson's disease. Neurology 2003;61:969.[Free Full Text]




This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shivakumar, R.
Right arrow Articles by Thomas, S. V.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Shivakumar, R.
Right arrow Articles by Thomas, S. V.
Related Collections
Right arrow All Imaging
Right arrow MRI
Right arrow Chorea
Right arrow Basal ganglia

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS