| Face of the giant panda sign | |
|---|---|
 | |
| Axial T2-weighted MRI of the brain at the level of the midbrain showing the characteristic ‘face of the giant panda’ sign, with normal red nuclei and substantia nigra (pars reticulata) against a background of hyperintensity in the tegmentum, as well as hypointensity of the superior colliculi | |
| Complications | choreoathetosis |
| Differential diagnosis | Wilson's disease, Wernicke's encephalopathy, Leigh syndrome, acute disseminated encephalomyelitis, toxic leukoencephalopathy, rabies |
| Medication | penicillamine, thiamine, corticosteroids |
The face of the giant panda sign, panda sign of the midbrain or double-panda sign is a characteristic "panda's face" appearance in magnetic resonance imaging (MRI) images of people with Wilson's disease. Along with Kayser–Fleischer rings, the sign is helpful in diagnosis.
While the sign is most common in Wilson's disease, it has been rarely reported in acute disseminated encephalomyelitis, rabies encephalopathy, toxic leukoencephalopathy and Leigh syndrome.
References
- Kuruvilla, A.; Joseph, S. (2000). "'Face of the giant panda' sign in Wilson's disease: Revisited". Neurology India. 48 (4): 395–6. PMID 11146611.
- Nagabushana, D.; Kumar, SP.; Nagaraj, K. (2020). "Giant Panda in ADEM". Neurol India. 68 (3): 720–1. doi:10.4103/0028-3886.289008. PMID 32643704. S2CID 220437811.
- Jassi, P.; Attri, A.; Dhawan, R.; Kakkar, C.; Saggar, K. (2016). "MR imaging in rabies encephalopathy: A rare entity". Ann Indian Acad Journal. 19 (1): 125–8. doi:10.4103/0972-2327.167712. PMC 4782530. PMID 27011645.
- Bimbato, EM.; Carvalho, AG.; Reis, F. (2015). "Toxic and metabolic encephalopathies: iconographic essay". Radiol Bras. 48 (2): 121–5. doi:10.1590/0100-3984.2013.1923. PMC 4433303. PMID 25987753.
- Sonam, K.; Bindu, P.; Gayathri, N.; Khan, N.; Govindaraju, C.; Arvinda, H.; Nagappa, M.; Sinha, S.; Thangaraj, K.; Taly, A. (2014). "The "double panda" sign in Leigh disease". J Child Neurol. 29 (7): 980–2. doi:10.1177/0883073813484968. PMID 23599247. S2CID 5969381.
Further reading
- Das, Shyamal K.; Ray, Kunal (2006). "Wilson's disease: An update". Nature Clinical Practice Neurology. 2 (9): 482–493. doi:10.1038/ncpneuro0291. PMID 16932613. S2CID 205340375.
- Jacobs, D. A.; Markowitz, C. E.; Liebeskind, D. S.; Galetta, S. L. (2003). "The "double panda sign" in Wilson's disease". Neurology. 61 (7): 969. doi:10.1212/01.WNL.0000085871.98174.4E. PMID 14557570.
- Shivakumar, R.; Thomas, S. V. (2009). "Teaching Neuro Images: Face of the giant panda and her cub: MRI correlates of Wilson disease". Neurology. 72 (11): e50. doi:10.1212/01.wnl.0000344409.73717.a1. PMID 19289731.
- Liebeskind, D. S. (2003). "Faces of the giant panda and her cub: MRI correlates of Wilson's disease". Journal of Neurology, Neurosurgery & Psychiatry. 74 (5): 682. doi:10.1136/jnnp.74.5.682. PMC 1738451. PMID 12700322.
- Gupta, A.; Chakravarthi, S.; Goyal, M. K. (2014). "'Face of giant panda': A rare imaging sign in Wilson's disease". QJM. 107 (7): 579. doi:10.1093/qjmed/hct217. PMID 24170891.
- Parekh, J. R.; Agrawal, P. R. (2014). "Wilson's disease: 'face of giant panda' and 'trident' signs together". Oxford Medical Case Reports. 2014 (1): 16–17. doi:10.1093/omcr/omu005. PMC 4369968. PMID 25988011.
- Singh, P.; Ahluwalia, A.; Saggar, K.; Grewal, C. S. (2011). "Wilson's disease: MRI features". Journal of Pediatric Neurosciences. 6 (1): 27–8. doi:10.4103/1817-1745.84402. PMC 3173909. PMID 21977083.
- Sonam, Kothari; Bindu, P.S.; Gayathri, Narayanappa; Khan, Nahid Akhtar; Govindaraju, C.; Arvinda, Hanumanthapura R.; Nagappa, Madhu; Sinha, Sanjib; Thangaraj, K.; Taly, Arun B. (2014). "The "Double Panda" Sign in Leigh Disease". Journal of Child Neurology. 29 (7): 980–982. doi:10.1177/0883073813484968. PMID 23599247. S2CID 5969381.
External links
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