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Sequential MRI changes in Wilson's disease with de-coppering therapy: a study of 50 patients

Departments of ¹ Neurology and Neuroimaging and ² Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

View larger version (84K): [in this window] [in a new window]   Figure 1. (a, b) FLAIR axial MR images performed in 1999 and 2002 showing improvement of signal changes noted in the putamen and lateral part of thalamus. (c, d) T1 weighted image axial MRI of brain in 1999 and 2002. It revealed improvement in diffuse cortical and subcortical atrophy as evident in repeat MRI after 4 years of de-coppering.

View larger version (71K): [in this window] [in a new window]   Figure 2. (a,b) FLAIR axial sequence showing the "giant panda" pattern in 1999, which has improved after 3 years of de-coppering therapy. (c,d) FLAIR sequence MRI of brain in 1999 revealing central pontine myelinosis-like changes, which resolved substantially after 3 years of treatment.

View larger version (80K): [in this window] [in a new window]   Figure 3. (a,b) T1 weighted image axial MRI of brain in 1998 showing brainstem and cerebellar atrophy. Further worsening of the brainstem and cerebellar atrophy was noted in the repeat MRI study in 2002. The cerebellum is replaced by cerebrospinal fluid in the figure. The patient suffered relentless progressive deterioration despite receiving the recommended treatment. (c,d) T2 weighted image axial MR image of brain showing an increase in putaminal signal changes while on regular treatment from 1999 to 2002.