Wilson's disease 🐼
A 36-year-old woman presented with severe dysarthria, axial and appendicular tremor, and ataxia. Symptoms began with the tremor 2 years prior to presentation. Neurologic examination revealed the presence of "Kayser–Fleischer rings", severe dysarthria and dysphonia, akathisia, truncal and appendicular tremor, left hemiparesis and dystonia. Serum ceruloplasmin was markedly decreased at 10 mg/dL (normal 18 to 55 mg/dL). An MRI revealed diffuse white matter abnormalities with bilateral symmetric involvement of the midbrain, pons, inferior cerebellum, thalami, internal capsules, external capsules and splenium of the corpus callosum. The MRI abnormalities in the midbrain reveal the “face of the giant panda sign" that is characteristic of Wilson’s disease