A 13-YEAR-OLD white male presented with a 2-year history of declining academic performance, symptoms of attention-deficit/hyperactivity disorder, and a 6-month history of progressive dysarthria and tremor. Neurologic examination showed emotional lability, motor impersistence, severe hypokinetic dysarthria, postural and intention tremor affecting the upper extremities, oromandibular and hand dystonia, and generalized rigidity. He had a shuffling gait and was unable to perform tandem gait. Magnetic resonance imaging showed increased signal intensity on T2-weighted images in basal ganglia (Figure 1) and throughout the subcortical white matter in the frontal lobes (Figure 2).
Hedera P, Brewer GJ, Fink JK. White Matter Changes in Wilson Disease. Arch Neurol. 2002;59(5):866-867. doi:10.1001/archneur.59.5.866