Presentation
Irrelevant talk, abnormal behavior, and difficulty in walking for 2 years, increased in severity in the last 4 months.
Patient Data
Symmetrical hyperintensity is noted in the bilateral caudate head, putamen, and thalamus on T2/FLAIR showing no restriction on DWI/ADC.
Transverse greyscale image showing coarse nodular liver.
Kayser-Fleischer ring is present.
Case Discussion
Symmetrical hyperintensities involving the caudate head, putamen, and thalamus were noted. On ultrasound correlation, liver cirrhosis was observed. Kayser-Fleischer ring visualized on examining the eye.
Sometimes the high signal intensity is noted in tegmentum with preservation of substantial nigra and red nucleus signal giving rise to the face of the giant panda sign is seen, however, this sign is not present in our case.
Differential diagnoses for the MRI brain findings are Leigh disease and pantothenate kinase-associated neurodegeneration (PKAN).
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