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Cerebrotendinous xanthomatosis: Imaging clues to an underdiagnosed disorder

Ankita Garg, Jayesh Modi, Mancy Mothsera, Rajiv Gupta

Case Reports in Clinical Radiology | Aug 8, 2026

Abstract

Abstract

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disorder resulting from defective bile acid synthesis, causing soft tissue deposition of cholesterol and cholestanol. It manifests with a wide spectrum of neurological as well as non-neurological features, leading to delayed diagnosis. We report a case of a 34-year-old male who presented with a 10-year history of seizures, followed by progressive neurological deterioration culminating in akinetic mutism. Magnetic resonance imaging (MRI) of the brain revealed characteristic signal abnormalities in bilateral dentate nuclei and surrounding cerebellar white matter. MRI of the ankle demonstrated marked enlargement and inhomogeneous infiltration of the Achilles tendon, consistent with tendon xanthoma. Genome sequencing confirmed the diagnosis of CTX. This case highlights the role of characteristic imaging findings in the early diagnosis and treatment of CTX.

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Authors

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Ankita Garg

first | Medanta The Medicity

Jayesh Modi

middle | Medanta The Medicity

Mancy Mothsera

middle | Medanta The Medicity

Rajiv Gupta

last | Medanta The Medicity | ORCID 0000-0001-9959-3501

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Citation

BibTeX

@article{Garg2026Cerebrotendinous,
  title = {Cerebrotendinous xanthomatosis: Imaging clues to an underdiagnosed disorder},
  author = {Ankita Garg and Jayesh Modi and Mancy Mothsera and Rajiv Gupta},
  journal = {Case Reports in Clinical Radiology},
  year = {2026},
  doi = {10.25259/crcr_26_2026},
  url = {https://doi.org/10.25259/crcr_26_2026}
}

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