imaging 

The imaging provided is showing T2 FLAIR hyperintensities of the caudate and putamen. This is consistent with imaging appreciated in Wilson’s disease. Although not seen in the axial cut provided, cuts of the midbrain would show hyperintensities and relative sparing of the red nucleus, also known as the “panda sign”. Wilson’s disease occurs secondary to an inborn error of copper metabolism. Elevated copper levels lead to neuronal death. Huntington’s disease leads to caudate atrophy. PKAN on MRI will show an “eye of the tiger sign”: a hypointense lesion in the bilateral basal ganglia with a central hyperintensity that represents gliosis. Toxic leukoencephalopathy can be secondary to inhaling heroin and has changes in white matter on MRI, particularly in the cerebellum.