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Medical condition
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.
[1]
While the sign is most common in Wilson's disease, it has been rarely reported in
acute disseminated encephalomyelitis ,
[2]
rabies encephalopathy,
[3]
toxic leukoencephalopathy
[4] and
Leigh syndrome .
[5]
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