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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?

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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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