case_images: PMC8374231_01
case_images: K-F rings in the patient (left eye).
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case_images: Slit-lamp examination showed the presence of Kayser-Fleischer (K-F) rings in both eyes (zigzag score: 2) (Figure 1).
case_images: Conventional brain MRI of WD. Lesions were hyperintense in the midbrain and cerebral peduncle and hypointense in the substantial nigra and red nucleus on (a) axial and (b and c) coronal T2WI-FLAIR, (d) hyperintense in the pons on T2WI-FLAIR, and (e) hypointensity in the midbrain on axial T1WI.
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case_images: Conventional brain MRI (General Electric Company, USA) results showed symmetrical hyperintensity in the midbrain and cerebral peduncle and hypointensity in the substantia nigra and red nucleus on T2WI-FLAIR (Figure 2a-c), hyperintense in the pons on T2WI-FLAIR (Figure 2d), and hypointensity in the midbrain on T1-weighted imaging (T1WI) (Figure 2e).
case_images: SWI and ASL-MRI of WD. (a and b) SWI showed decreased signal intensities in putamen, globus pallidus, substantia nigra, and red nucleus. (c and d) ASL-MRI demonstrated the reduction of cerebral blood flow in the bilateral putamen. (e) T1WI, and (f) T2WI showed substantially normal in the putamen, globus pallidus, substantial nigra, and red nucleus.
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case_images: SWI showed marked hypointensity in the substantia nigra, red nucleus, and lenticular nucleus (Figure 3a and b). ASL-MRI showed a slight decrease in cerebral blood flow (CBF) to the lenticular nucleus, with the left and right putamen being 40.4 mL/100 g/min and 38.5 mL/100 g/min, respectively (Figure 3c and d). T1WI and T2WI (Figure 3e and f) (Table 1). The MRS changes of the patient in the lenticular nucleus and midbrain were unremarkable.