MR Imaging Characteristics and Neuropathology of the Spinal Cord in Adult-Onset Autosomal Dominant Leukodystrophy with Autonomic Symptoms

Sagittal T2-weighted image of the cervical spine in a 49-year-old woman with adult-onset ADLD with autonomic symptoms. Her symptoms consisted of micturition urgency and slight pyramidal affection. The spinal cord is thin, and slight SI changes in the posterior part of the spinal cord, easily mistaken for truncation artifacts, are seen (arrow).

T2-weighted MR image of the cervical spine in the most severely affected patient, a man 51 years of age with paraparesis, severe dysautonomia, and ataxia. Severe atrophy of the spinal cord is seen, and diffuse SI changes are not confined to the posterior part of the spinal cord.

Transverse T2-weighted images of the spinal cord at the C2 and T6 levels of a healthy control subject (A), along with images of the same levels in an asymptomatic ADLD family member (B) and in the same patients as seen in Figs 2 and 3 (C and D, respectively). In all ADLD family members, a general white matter SI increase is seen and a reduction in the cross-sectional area. The thinning of the spinal cord seems to worsen with progression of symptoms. D, Parts of the dorsal columns have an increased SI indistinguishable from that in white matter SI.

Fluid-attenuated inversion recovery images of the brain in the same patient as in Fig 2. Increased white matter SI can be seen beneath the motor cortex and in the upper part of the parietal lobes. The SI changes can be followed along the corticospinal tract including the pyramids (arrow) and in the cerebellar peduncles. A periventricular rim with less increased signal intensity is characteristic of adult-onset ADLD with autonomic symptoms.

In the spinal cord, no obvious loss of myelinated fibers, neither in the myelin-stained (A) nor in the silver-stained for axons (B), is detectable at a low magnification. A, Luxol fast blue-cresyl violet. B, Bielschowsky silver. Ventral part down.