Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 68 71 Salsabeel Hamad Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Israa Abufara Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Safaa Zagharneh Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Taimaa Abureesh Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Afnan Jobran Faculty of Medicine, Al-Quds University, Jerusalem, Palestine. 2023 08 09 2023 08 16 Metachromatic Leukodystrophy (MLD) is commonly characterized by the accumulation of sulfatide in various organs, including the central nervous system, leading to neurological and mental symptoms. We reported a case of a two-year-old male patient with psychomotor retardation history, developmental delay, poor overall performance and imaging findings compatible with Leukodystrophy are presented. The goal of this case report is to identify clinical presentation and typical MRI features to diagnose MLD, in the absence of an enzyme assay or a gene mutation investigation. https://crcp.tums.ac.ir/index.php/crcp/article/view/857