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A 12 year old girl was admitted for poor school performance, and slurring of speech for the past three months. Of late she was noticed to have involuntary movements and tremors. She also had mood changes. She had no significant past illness. Family history was insignificant except that her brother had recurrent episodes of jaundice from the age of 5 years. Examination revealed mild hypertonicity of all four limbs, ataxia, and intention tremor with mild pallor. Examination of the eyes suggested the diagnostic approach.
Kayser Fischer ring is a golden brown deposit at the level of the Descemet’s membrane of the cornea, and is seen in various conditions such Wilson’s disease and primary biliary cirrhosis.
Kayser Fischer ring is seen in most Wilson disease cases presenting with neurological symptoms. It may be visualised sometimes with the naked eye examination, but a slit lamp examination is always required to rule it out.
Competing interests: none declared
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