JRCR - Journal of Radiology Case Reports JRCR - Journal of Radiology Case Reports
Discussion started by Noha Madkour 8 months ago

  • Dear Dr Roland Talanow, JRCR editor:

    I am Dr. Noha Madkour . I have uploaded a case report titled ' MRI brain T2 hyperintensities in old patient with wilson disease and a review of differential diagnosis' for resubmission. I hope it will be considered for pre-screening .

    The case description is :

    Wilson disease or hepatolenticular degeneration is a worldwide inherent gene disorder leads to deposition of cupper in various tissues. The disease usually presents before the age of forty. However, few studies report upon late-onset wilson’s disease presenting in older age. In this case report, an old male patient presenting with wilson’s disease is discussed. A 56- year old male patient was referred to the hospital presenting with unsteadiness of gait, abnormal posturing, incoordination in speech and dizziness with gradual onset and progressive course of five months duration. Neurological examination revealed dysarthria, ataxia and dyskinesia. No overt hepatic manifestations. Ophthalmic examination revealed kasyer-fleischer ring. Laboratory test included elevated 24-hour urinary cupper excretion at level 250 μg/day (N: 50-70 μg/day). No liver biopsy was ordered by the referring physician.

            MRI brain revealed bilateral symmetrical hyperintensities in T2 weighted images (T2WI) (figures 1,2) and in fluid-attenuation inversion recovery (FLAIR) (figure 4) involving both putamena mainly the peripheral rim (figure 1), both glopi pallidi, both caudates and bilateral middle cerebellar peduncles. In contrast to T2WI, lesions appear iso-hypointense in T1WI (figure 5). Typical hyperintense T2 signal was noted in the tegmentum of midbrain in axial section giving the characteristic “Face of giant panda” (figure 3) with preserved signal of the red nucleus, preserved hypointense signal of the lateral portion of pars reticulata of substantia nigra and hypointense superior colliculus.


    The diagnosis of Wilson's disease was concluded according to clinical, laboratory data and MRI brain findings.

    Thank you

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