An 8-year-old girl presented with a 5-day history of double vision on attempting to look downward. Examination of her eye movements revealed weakness of bilateral superior oblique muscles, with a normal examination otherwise. The brain MRI revealed a cysticercal granuloma of the midbrain ventral to the cerebral aqueduct with perilesional edema, sparing both red nuclei, and giving the appearance of “face of panda” (figure, A and B). The face of panda sign has been described in cases of Wilson disease, including “face of giant panda” and “face of panda cub” in the midbrain and pons, respectively.1,2
Axial fluid-attenuated inversion recovery (A) and T2-weighted (B) MRI of midbrain reveal a cyst with mural nodule, in the periaqueductal grey matter, ventral to the aqueduct. Edema involving the surrounding white matter, sparing the red nuclei and cerebral peduncles, is seen.
Footnotes
Author contributions: R.K., L.L., and B.H.S. provided clinical care to the patient and drafted the manuscript. D.R.V. provided radiologic input.
Study funding: No targeted funding reported.
Disclosures: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2013 American Academy of Neurology
References
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