Wilson's disease in two siblings from Ecuador: Two case reports

Figure 3 The 'double panda' sign in magnetic resonance imaging of Case 1. A: Fluid-attenuation inversion recovery (FLAIR) magnetic resonance imaging (MRI) scan with an axial section view at the level of the midbrain exhibits the classic 'giant panda' sign (orange arrow), where the mesencephalic tegmentum shows increased T2 signal intensity, highlighting the contrast of the substantia nigra, corresponding to the ‘bear ears’, as well as the red nuclei, corresponding to the ‘bear eyes’; B: Image of the giant panda (Ailuropoda melanoleuca), licensed under creative commons; C: Image of the red panda (Ailurus fulgens), licensed under creative commons; D: FLAIR MRI scan with an axial section at the pons level shows the ‘small panda’ sign (orange arrow) in the pontine tegmentum, where increased T2 signal intensity allows better differentiation of the medial longitudinal fasciculi and central tegmental tracts, representing the ‘eyes of the bear’, and the superior angle of the fourth ventricle represents the ‘nose of the bear’.