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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]).

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


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Conflict of interest:

There is no conflict of interest to declare.

  • 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

Address for correspondence

Elison Sarapura-Castro

Publication History

Received: 06 March 2020

Accepted: 23 March 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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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

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