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Letters   |    
Bipolar I Disorder Presaging X-Linked Adrenoleukodystrophy
Kok-Yoon Chee, M.Med. (Psych); Beng-Hui Ong, M.R.C.P.; Abdul Latif Kartikasalwah, M.Med. (Radiology); Hock-Lock Ngu, M.R.C.P.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E20-E22. doi:10.1176/appi.neuropsych.12060142
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Dept. of Psychiatry and Mental Health, Kuala Lumpur Hospital
Dept. of Neurology, Kuala Lumpur Hospital
Dept. of Radiology and Diagnostic Imaging, Kuala Lumpur Hospital
Dept. of Genetics and Metabolic Disorders, Kuala Lumpur Hospital

Correspondence: Dr. Chee Kok-Yoon; e-mail: cheekokyoon@yahoo.com

Copyright © 2013 American Psychiatric Association

Extract

To the Editor: We reported on a young adult who presented with Bipolar I disorder and later was identified to have suffered from X-linked adrenoleukodystrophy (ALD). He has Addison’s disease and abnormal ratio in very-long-chain fatty acid; mutational analysis revealed an ABCD1 mutation. Brain imaging showed symmetrical, confluent, bilateral signal-intensity changes in the parieto-occipital deep white matter, splenium of corpus callosum, and the corticospinal tract region. This case illustrated complexity in diagnosis and how a diagnosis of ALD could easily be missed.

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FIGURE 1. T2-weighted MR images of the brain show symmetrical bilateral signal intensity changes in the parieto-occipital deep white matter and in the splenium of the corpus callosum (upper left and right); increased signal-intensity in the acoustic radiation (thick arrows), in the posterior limb of the internal capsule (upper right, lower left); and subtle changes in signal-intensity in the lateral lemniscus (thin arrows). The U fibers are completely spared in all areas. (Focal lesion at bilateral corona radiata, at the corticospinal tract region with heterogeneous enhancement of the left corona radiata lesion in post-IV contrast images.)
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