Figure 4f. Childhood cerebral X-linked ALD in a 9-year-old boy in whom the disease had been diagnosed with serologic testing and genetic study 2 years earlier. Although the patient had a symptomatic older brother with childhood cerebral X-linked ALD, he himself remained asymptomatic throughout the 2-year follow-up period. (a–c) Initial brain MR (FLAIR) images show subtle bilateral signal intensity changes in the parieto-occipital deep white matter and in the splenium of the corpus callosum. (d–f) On brain MR images obtained 7 months later, the lesions in the parieto-occipital white matter seem to be aggravated. New signal intensity changes are also demonstrated in the left medial geniculate body (arrow in e), lateral lemniscus (arrowhead in f), and brachium of the inferior colliculus (arrow in f). MR imaging performed 5 months later showed no interval change.