Adrenoleukodystrophy: Unusual Computed Tomographic Appearance

Adrenoleukodystrophy (ALD) is a disorder in which cerebral demyelination is associated with adrenal insufficiency. It is sex-linked, usually familial, and occurs almost exclusively in males. It is thought to be caused by an abnormal accumulation of saturated long-chain fatty acids in cholesterol esters of the brain and the adrenal glands and in gangliosides.1 The computed tomographic (CT) appearance of ALD has been characterized by symmetry of lesions in the cerebral white matter, late atrophy, variable megaloencephaly, and the absence of mass effect.2-4We report the clinical, pathologic, and CT findings of a boy with ALD whose CT brain scan initially demonstrated a unilateral low-attenuation lesion in the white matter of the parietal lobe with ventricular distortion suggestive of mass effect. Subsequently, the lesion showed central enhancement with surrounding low attenuation. Later scans disclosed bilateral enhancement in the white matter of the internal and extreme capsules. REPORT OF