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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(08): 525
DOI: 10.1590/0004-282X20200036
Images in Neurology

Panda with “bright eyes”: a rare sign in Wilson disease

Panda con “ojos brillantes”: un signo raro en la enfermedad de Wilson
Elison SARAPURA-CASTRO 
1   Instituto Nacional de Ciencias Neurologicas, Neurogenetics Research Center, Lima, Peru.
2   University of Washington, Northern Pacific Global Health Research Fellows Training Consortium, Seattle, USA.
,
Jorge RAMÍREZ-QUIÑONES 
3   Instituto Nacional de Ciencias Neurologicas, Department of Cerebrovascular Disease, Lima, Peru.
,
Mario CORNEJO-OLIVAS 
1   Instituto Nacional de Ciencias Neurologicas, Neurogenetics Research Center, Lima, Peru.
4   Universidad Peruana Cayetano Heredia, Center for Global Health, Lima, Peru.
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A 22-year-old man with one-year history of progressive dysarthria, dysphagia, drooling, ataxic gait, and disinhibition. He reported history of acute hepatitis five months ago. Neurological examination revealed bilateral upper limb action tremor, parkinsonism, hyperreflexia, and clonus. Low serum ceruloplasmin levels (7.6 mg/dL, Normal: 20-40 mg/dL) and Kayser-Fleischer rings in the cornea were detected. Brain MRI showed abnormal bilateral hyperintensities ([Figure 1]) and panda with “bright eyes” ([Figure 2]).

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Figure 1 Axial FLAIR image demonstrates hyperintensities with central dark signal intensity in the putamen and caudate nuclei, and hyperintensities in thalami.
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Figure 2 The red nuclei appear bright in axial T2-weighted image with the appearance of panda with “bright eyes”.

Panda with “bright eyes” is a rare variant of the neuroimaging sign called “face of the giant panda”, associated with Wilson disease[1],[2]. It is probably related to paramagnetic effects of cooper and iron accumulation in the red nuclei.



Publikationsverlauf

Eingereicht: 06. März 2020

Angenommen: 23. März 2020

Artikel online veröffentlicht:
13. Juni 2023

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  • References

  • 1 Kallollimath P, Nagappa M, Sinha S, Saini J, Bindu PS, Taly AB. Panda with «Bright eyes» in Wilson’s disease. Neurol India. 2013 Jan/Feb;61(1):100-1. https://doi.org/10.4103/0028-3886.108052
  • 2 Hitoshi S, Iwata M, Yoshikawa K. Mid-brain pathology of Wilson’s disease: MRI analysis of three cases. J Neurol Neurosurg Psychiatry. 1991 Jul;54(7):624-6. https://doi.org/10.1136/jnnp.54.7.624