What are the key radiological features of adrenoleukodystrophy in terms of head size, age of onset, and specific patterns of white and gray matter involvement?

Adrenoleukodystrophy typically presents with normal head size and an age of onset between 5-10 years. Radiologically, it shows symmetric involvement of the occipital white matter and the splenium of the corpus callosum, with no gray matter involvement. It is a sex-linked recessive condition affecting boys due to a peroxisomal enzyme deficiency. Key diagnostic features include the characteristic pattern of white matter demyelination on MRI, often with gadolinium enhancement in active disease. Clinically, it can be mistaken for other leukodystrophies or metabolic disorders, so correlating clinical and radiological findings is crucial.