face of the giant panda sign face of the giant panda sign the face of the giant panda sign, panda sign of the midbrain or double-panda sign is a characteristic "panda's face" appearance in magnetic resonance imaging (mri) images of people with wilson's disease. along with kayser–fleischer rings, the sign is helpful in diagnosis. face of the giant panda signaxial t2-weighted mri of the brain at the level of the midbrain showing the characteristic ‘face of the giant panda’ sign, with normal red nuclei and substantia nigra (pars reticulata) against a background of hyperintensity in the tegmentum, as well as hypointensity of the superior colliculicomplicationschoreoathetosisdifferential diagnosiswilson's disease, wernicke's encephalopathy, leigh syndrome, acute disseminated encephalomyelitis, toxic leukoencephalopathy, rabiesmedicationpenicillamine, thiamine, corticosteroids while the sign is most common in wilson's disease, it has been rarely reported in acute disseminated encephalomyelitis, rabies encephalopathy, toxic leukoencephalopathy and leigh syndrome.