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Kayser-Fleischer rings were visible without slit-lamp examination on clinical exam, as were prominent hand tremors and ataxia on finger\u2013nose\u2013finger task. Brain MRI showed increased T2\/FLAIR (fluid-attenuated inversion recovery) signal within the thalami, midbrain and pons demonstrating a \u2018double panda sign\u2019. Laboratory findings confirmed a diagnosis of Wilson\u2019s disease. Penicillamine and subsequent zinc therapy were initiated. Patient was eventually discharged home with plans for outpatient physical therapy and hepatology management. Two months from presentation, the patient reported significant improvement in ataxia, motor function, swallow function and incontinence.<\/jats:p>","DOI":"10.1136\/bcr-2021-246296","type":"journal-article","created":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T12:10:18Z","timestamp":1656936618000},"page":"e246296","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Wilson\u2019s disease: neuropsychiatric presentation and delayed diagnosis"],"prefix":"10.1136","volume":"15","author":[{"given":"Palvasha","family":"Deme","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, UT Southwestern, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Sheffield","sequence":"additional","affiliation":[{"name":"Department of Neurology, UT Southwestern, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5859-0862","authenticated-orcid":false,"given":"Sasha","family":"Alick-Lindstrom","sequence":"additional","affiliation":[{"name":"Department of Neurology, UT Southwestern, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,7,4]]},"reference":[{"key":"2025082712253885000_15.7.e246296.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60196-2"},{"key":"2025082712253885000_15.7.e246296.2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1179\/1743132813Y.0000000262","article-title":"Comprehensive analysis on clinical features of Wilson's disease: an experience over 28 years with 133 cases","volume":"36","author":"Lin","year":"2014","journal-title":"Neurol Res"},{"key":"2025082712253885000_15.7.e246296.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2011.11.007"},{"key":"2025082712253885000_15.7.e246296.4","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.54.7.624"},{"key":"2025082712253885000_15.7.e246296.5","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000085871.98174.4E"},{"key":"2025082712253885000_15.7.e246296.6","doi-asserted-by":"publisher","DOI":"10.1007\/BF00716470"},{"key":"2025082712253885000_15.7.e246296.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2009.05109.x"},{"key":"2025082712253885000_15.7.e246296.8","doi-asserted-by":"crossref","first-page":"S65","DOI":"10.21037\/atm.2018.12.53","article-title":"Clinical practice guidelines in Wilson disease","volume":"7","author":"Saroli Palumbo","year":"2019","journal-title":"Ann Transl Med"},{"key":"2025082712253885000_15.7.e246296.9","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22261"},{"key":"2025082712253885000_15.7.e246296.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.03959.x"},{"key":"2025082712253885000_15.7.e246296.11","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2.9.1473"},{"key":"2025082712253885000_15.7.e246296.12","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/153.4.372"},{"key":"2025082712253885000_15.7.e246296.13","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1353\/hpu.2013.0019","article-title":"Barriers to health care among Asian immigrants in the United States: a traditional review","volume":"24","author":"Clough","year":"2013","journal-title":"J Health Care Poor Underserved"},{"key":"2025082712253885000_15.7.e246296.14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1007\/s11606-007-0340-z","article-title":"Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use","volume":"22 Suppl 2","author":"Ngo-Metzger","year":"2007","journal-title":"J Gen Intern Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-246296","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:25:46Z","timestamp":1756322746000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-246296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":14,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,4]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1136\/bcr-2021-246296"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-246296","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}