LAUSR

Annals of Indian Academy of Neurology ¦ Volume 24 ¦ Issue 6 ¦ November-December 2021 999 malignancies.[1] Late‐onset type (symptom onset after 4 years of age) is rarer with approximately 80 cases described worldwide[2] and has a less severe presentation, and therefore a better prognosis with early treatment.[1] However, diagnosis is often delayed/missed due to the rarity of disease and lack of awareness about the same.[2] The usual presentation includes cognitive decline, neuropsychiatric abnormalities, hematological manifestations, and features suggestive of subacute combined degeneration (SACD) of the spinal cord.[1] Cerebral or cerebellar atrophy and hyperintensities in the white matter have been described on imaging.[3]