title: The "double panda" sign in Leigh disease.
abstract: Although the "face of the giant panda" sign on magnetic resonance imaging (MRI) is traditionally considered to be characteristic of Wilson disease, it has also been reported in other metabolic disorders. This study describes the characteristic "giant panda" sign on MRI in a child with Leigh disease. The diagnosis was based on the history of neurological regression; examination findings of oculomotor abnormalities, hypotonia, and dystonia; raised serum lactate levels; and characteristic brain stem and basal ganglia signal changes on MRI. The midbrain and pontine tegmental signal changes were consistent with the "face of the giant panda and her cub" sign. In addition to Wilson disease, metabolic disorders such as Leigh disease should also be considered in the differential diagnosis of this rare imaging finding.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Kothari
authors.initials: K
authors.lastname: Sonam
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India drpsbindu@yahoo.co.in.
authors.forename: P S
authors.initials: PS
authors.lastname: Bindu
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Narayanappa
authors.initials: N
authors.lastname: Gayathri
authors.affiliation: Department of Evolutionary and Medical Genetics, Centre for Cellular and Molecular Biology, Hyderabad, India.
authors.forename: Nahid Akhtar
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: C
authors.initials: C
authors.lastname: Govindaraju
authors.affiliation: Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Hanumanthapura R
authors.initials: HR
authors.lastname: Arvinda
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Nagappa
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Evolutionary and Medical Genetics, Centre for Cellular and Molecular Biology, Hyderabad, India.
authors.forename: K
authors.initials: K
authors.lastname: Thangaraj
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Arun B
authors.initials: AB
authors.lastname: Taly
mesh_terms: D001921:Brain / Q000473:pathology*; D002675:Child, Preschool; D003241:Consanguinity; D005260:Female; D006801:Humans; D007888:Leigh Disease / Q000473:pathology*; D008279:Magnetic Resonance Imaging
keywords: Leigh disease; Wilson disease; double panda; face; giant panda; mitochondrial disease