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Images in paediatrics
A toddler with worsening gait and leopard skin sign on MRI
  1. Sohail Ghani1,
  2. Toni Williams2,
  3. Marcus Likeman3,
  4. Efstathia Chronopoulou4
  1. 1 Department of Paediatric Neurosciences, Bristol Royal Hospital for Children, Bristol, UK
  2. 2 Department of Paediatrics, Hywel Dda University Health Board, Glangwili General Hospital, Carmarthen, UK
  3. 3 Department of Paediatric Neuroradiology, Bristol Royal Hospital for Children, Bristol, UK
  4. 4 Department of Paediatric Metabolic Disorders, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Dr Sohail Ghani, Consultant Paediatrician, 2 Lon Y Deri, Rhiwbina, Cardiff, CF14 6JN, UK; sohailghani2001{at}

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Case history

A three-and-half-year-old child presented with speech delay and recent onset falls. He walked at 14 months of age but speech was delayed with limited vocabulary.

He had become increasingly unsteady with weakness and pain in his legs in the past 6 months. The lower limb examination revealed no muscle wasting but hypertonia, hyper-reflexia, extensor plantar response and 4-beat ankle clonus bilaterally. He had bilateral foot-drop gait. The rest of the …

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