Neuroimaging: face of the giant panda sign: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: face of the giant panda sign

Sample item

A 20-year-old has tremor, dysarthria and a Kayser-Fleischer ring. Axial T2 MRI of the midbrain shows high signal in the tegmentum with preserved red nuclei and superior colliculi. What is this sign?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Face of the giant panda sign of Wilson disease

In Wilson disease the midbrain tegmentum becomes hyperintense while the red nuclei and the lateral substantia nigra remain dark, forming the panda face. The eye of the tiger sign is seen in the globus pallidus in pantothenate kinase associated neurodegeneration.

Option by option

  • A. Hot cross bun sign

    The hot cross bun sign is a pontine sign of MSA.

  • B. Eye of the tiger sign

    Eye of the tiger is a pallidal sign of PKAN.

  • C. Mickey Mouse sign

    The Mickey Mouse sign is a midbrain outline pattern described in progressive supranuclear palsy.

  • D. Face of the giant panda sign of Wilson disease (correct)

    Correct. The panda face is a midbrain sign in Wilson disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Face of the giant panda sign of Wilson disease. In Wilson disease the midbrain tegmentum becomes hyperintense while the red nuclei and the lateral substantia nigra remain dark, forming the panda face.

Why is "Hot cross bun sign" not the answer?

The hot cross bun sign is a pontine sign of MSA.

Why is "Eye of the tiger sign" not the answer?

Eye of the tiger is a pallidal sign of PKAN.

Why is "Mickey Mouse sign" not the answer?

The Mickey Mouse sign is a midbrain outline pattern described in progressive supranuclear palsy.

What concept does this question test?

It tests Neuroimaging: face of the giant panda sign in Radiology. The eye of the tiger sign is seen in the globus pallidus in pantothenate kinase associated neurodegeneration.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: face of the giant panda sign?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.