Midbrain neurocysticercal granuloma appearing as 'face of panda'

An 8-year-old girl presented with a 5-day history of double vision on attempting to look downward. Examination of her eye movements revealed weakness of bilateral superior oblique muscles, with a normal examination otherwise. The brain MRI revealed a cysticercal granuloma of the midbrain ventral to the cerebral aqueduct with perilesional edema, sparing both red nuclei, and giving the appearance of “face of panda” (figure, A and B). The face of panda sign has been described in cases of Wilson disease, including “face of giant panda” and “face of panda cub” in the midbrain and pons, respectively.1,2