Clinical Presentation

A 5-year-old boy with learning delays and gait abnormality.

(A) Axial fluid-attenuated inversion recovery (FLAIR) image: there is abnormally high signal in the peritrigonal white matter and corpus callosum (arrows). (B) Coronal T1 post-contrast image: there is linear enhancement along the leading edge of the demyelination adjacent to the subcortical U-fibers (arrows).

Differential Diagnosis

• X-linked adrenoleukodystrophy: These findings are typical of adrenoleukodystrophy.

• Posterior reversible encephalopathy syndrome: This usually affects the cortical and subcortical regions in an asymmetric distribution and has variable patchy enhancement.

• Periventricular leukomalacia: