Axial T2-weighted MRI through the midbrain of a 19-year-old with tremor and cirrhosis shows symmetrical hyperintensity of the tegmentum with sparing of the red nuclei and the substantia nigra. This 'face of the giant panda' sign is seen in:

• A Wilson disease ✓
• B Wernicke encephalopathy
• C Olivopontocerebellar atrophy
• D Pantothenate kinase-associated neurodegeneration

Explanation

The giant panda face sign describes midbrain signal abnormality in Wilson disease: the tegmentum is hyperintense except for preserved low signal of the red nuclei, which form the eyes, and the substantia nigra pars reticulata, which form the ears. It reflects copper-mediated gliosis and oedema. Pantothenate kinase deficiency instead gives low T2 signal with a central high focus in the globus pallidus, the eye of the tiger pattern.

Reference: Grainger and Allison Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.