In a young patient with parkinsonian features, which evaluation helps to rule out Wilson disease?

• A. Brain MRI
• B. Serum ceruloplasmin with urinary copper
• C. Vitamin B12 level
• D. LP

Answer: (B)

Wilson disease is a treatable cause of parkinsonian features in young people due to copper buildup in the brain from impaired copper excretion. The best way to rule it out is to assess copper metabolism directly: measure serum ceruloplasmin and evaluate urinary copper excretion. In Wilson disease, ceruloplasmin is often low and urinary copper is elevated because copper is not properly incorporated into ceruloplasmin and cannot be excreted via bile. When you see this pattern—low ceruloplasmin with high urinary copper—it strongly supports Wilson disease and prompts definitive confirmation and treatment. If ceruloplasmin is normal or results are inconclusive but suspicion remains, hepatic copper quantification or genetic testing can help. Brain MRI can show nonspecific basal ganglia changes, but it’s not diagnostic for Wilson disease. Vitamin B12 level and LP don’t address this condition.