Face of the giant panda sign

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]

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

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]