MRI of the brain


MRI of the brain is shown below and you note an increased signal on T2-weighted and decreased signal on T1-weighted images in the frontal white matter.

How would you proceed regarding the patient’s workup?

A. Perform mutational analysis for exon 1, position 249 of glial fibrillary acidic protein cDNA
B. Schedule brain biopsy with histopathologic examination and specify that a portion of the specimen be sent for electron microscopy
C. Schedule the patient for a follow up in 6 months, no further testing required at this time
D. Perform neuro-metabolic investigations 
E. Schedule a family meeting to discuss the diagnosis, as no further workup is required 

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