Presentation
Dysarthria, parkinsonism, gait disturbance.
Patient Data
Bilateral symmetrical hypodensity in both basal ganglia (putamen), caudate nuclei, and ventrolateral thalami, Also noted hypodensity in midbrain, periaqueductal, posterior pons. There is a small calcification at the wall of the left lateral ventricle.
There are bilateral symmetrical hyperintensities on both T2W and FLAIR sequences in both lentiform nuclei (putamina), caudate nuclei, and ventrolateral aspect of both thalami.
Also noted hyperintensity in both T2W and FLAIR sequences in brainstem involving the midbrain and pons.
Case Discussion
Known case of Wilson disease with CNS manifestations, in the form of bilateral symmetrical hyperintensity of both basal ganglia and the brainstem.