Late onset divergent squint, poor balance, disorientation, swallowing difficulty. To exclude intracranial pathology.
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Increased T2-weighted signal change in the white matter of the parietal, occipital and temporal lobes cantered around the trigones of the lateral ventricles and extending across the splenium and posterior body of the corpus callosum. Focal increased T2-weighted signal change in the globus pallidus nuclei, anterior commissure, cerebral peduncles and midbrain.
The leading edge of the lesion shows restricted diffusion.
The appearances are in keeping with adrenoleukodystrophy. The restricted diffusion at the leading edge suggests that this is active.
The gender, age and clinical symptoms are consistent with this diagnosis and this was confirmed with genetic testing.