Typical brain magnetic resonance imaging (MRI) patterns in adult bulbospinal Alexander disease (type II)

In the bulbospinal (type II) form that typically presents in adults, the frontal white matter may be mildly involved as shown in (A) but is often mostly spared (B). Supratentorially, despite the paucity of white matter findings, basal ganglia abnormalities (C) and a periventricular rim (D) are often present. The most frequent brainstem finding is medullary atrophy (E to G). Cerebellar abnormalities are common (G). The medulla or cerebellum may enhance post-gadolinium (H).