Differential Diagnosis of Leukodystrophy by Clinicopathologic Pattern 

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Rosenthal fibers

• Alexander’s disease

Spongiform

• Canavan’s disease and other metabolic diseases due to abnormal amino acid metabolism

Globoid cells

• Globoid cell leukodystrophy (Krabbe disease)

Metachromatic material

• Metachromatic leukodystrophy

Sudanophilic material (sudanophilic leukodystrophy)

• Demyelination, perivascular lymphocytic infiltration, adrenal atrophy

• X-linked adrenoleukodystrophy (X-ALD)

• Neonatal adrenoleukodystrophy

• Scanty sudanophilic material, patchy perivascular preservation of myelin

• No dysmorphic feature

• Pelizaeus-Merzbacher disease

• Typical dysmorphic features, cerebral calcification

• Cockayne’s syndrome

• Sudanophilic leukodystrophy with other features

• With calcification

• With pigmented cells

• With cavitation and oligodendrocyte proliferation

• With meningeal angiomatosis

• Sudanophioic leukodystrophy with no other features