Legend The T2W image (Left) shows brain volume loss. The white matter is high signal because it is not myelinated. The FLAIR image looks like a T1W image because there is essentially no myelination of the lobar white matter.

Legend Coronal T1W images reveal some myelination of the cerebellum, brain stem, and internal capsules but little in the lobar white matter. Overall, the pattern represents markedly delayed myelination for a 7 year old boy.

Legend MR spectroscopy shows decreased NAA and increased glutamates, lipids and lactate, as well as a ketone peak at 2.2 ppm due to metabolic acidosis. Key words: mri mrs metabolic

Brain Diagnosis: Leigh's disease with lactic acidosis