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

Panda con “ojos brillantes”: un signo raro en la enfermedad de Wilson

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).

Figure 1.
Axial FLAIR image demonstrates hyperintensities with central dark signal intensity in the putamen and caudate nuclei, and hyperintensities in thalami.

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.

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
  » https://doi.org/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
  » https://doi.org/https://doi.org/10.1136/jnnp.54.7.624

Publication Dates

• Publication in this collection
  29 June 2020
• Date of issue
  Aug 2020

History

• Reviewed
  19 Dec 2019
• Received
  06 Mar 2020
• Accepted
  23 Mar 2020