A 55 year-old male (HA133) diagnosed with spastic paraplegia, pyramidal signs, ataxia, neurogenic lower urinary tract dysfunction harbored three deleterious variants associated to three diverse neurological disorders: a hemizygous variant in ABCD1 associated with adrenoleukodystrophy (MIM #300100); a heterozygous variant in GFAP associated with Alexander disease (ALXDRD, MIM #203450); and a heterozygous variant in COL4A1 associated with microangiopathy and leukoencephalopathy pontine (PADMAL, MIM #618564). Here, COL4A1 is linked to Alexander disease.