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Severe Adulthood Leukoencephalopathy: Highlighting Brain Adaptability to Insult

Leukoencephalopathy refers to disorders primarily affecting the white matter of the brain and generally present with progressive symptoms depending on underlying cause and pattern of white matter involvement.Leukoencephalopathies first diagnosed in adulthood are relatively uncommon but are important to recognize given the inherited nature of these disorders and potential for therapeutic management that may impact clinical course. Here, we report a case of incidentally found, idiopathic adulthood leukoencephalopathy with striking imaging findings. A 66-year-old right-handed man with past medical history of type 2 diabetes was rear-ended by a truck resulting in significant back and neck discomfort, for which he sought care in local emergency department. Prior to the accident, our patient was fully functional in all activities of daily living and operating his own business. Neurologic exam was notable for difficulty following multistep commands, ocular motor apraxia, and simultagnosia. He had normal strength and coordination, while gait was relatively normal with stooped posture. Computed tomography (CT) head obtained in the emergency department revealed diffuse white matter changes, which prompted magnetic resonance imaging (MRI) of the brain visualizing prominent white matter volume loss and cavitary lesions consistent with dysmyelination or diffuse cystic leukodystrophy. Notably, there was relative preservation of the cerebral cortex and deep gray nuclei. Figure 1 shows both the CT head andMRI brain imaging findings. Our patient had no known perinatal injury or developmental difficulties as a child. He graduated from high school. Family history was negative. He had an extensive negative evaluation