Presentation
Change in behavior, and learning difficulty at school
Patient Data
Axial MRI sequences show symmetrical peritrigonal white matter lesion which is hypointense on T1-weighted imaging and hyperintense on T2WI/FLAIR sequences, which also involves the splenium of the corpus callosum, as well as the cerebral peduncles and cerebellar white matter. An intermediate zone of active demyelination shows restricted diffusion.
Case Discussion
Adrenoleukodytrophy is an inherited peroxisomal disorder, resulting in accumulation of very long chain fatty acids (VLCFAs) in the white matter which causes severe inflammatory demyelination.
X-linked adrenoleukodystrophy is the most common single protein or enzyme deficiency disease to present in childhood, almost seen exclusively in boys age 5-12 years, and has a posterior-predominant pattern.