Exceptional involvement of medulla oblongata in Wilson disease

A 19-year-old man presented with a 1.5-month history of hypokinetic dysarthria, slight hypokinesia, and micrographia. Brain MRI showed fluid-attenuated inversion recovery (FLAIR) (figure 1) and T2 (figure 2) hyperintensities in the medulla oblongata and the mesencephalon. Copper tests reported high 24-hour urinary copper excretion, low serum copper, low ceruloplasmin, and high exchangeable copper. Kayser-Fleischer rings were present. ATP7B genetic analysis confirmed the diagnosis of Wilson disease (WD) with the presence of 2 mutations.

from Neurology recent issues http://bit.ly/2IjfYDW