LAUSR

Annals of Indian Academy of Neurology ¦ Volume 25 ¦ Issue 4 ¦ July-August 2022 720 Dear Editor, Adult‐onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare cause of adult‐onset leukodystrophy. It is most often inherited in an autosomal dominant mode and was previously known as hereditary leukoencephalopathy with axonal spheroids. Typically, patients in their middle age present with progressive cognitive decline and behavioral changes with pyramidal or extra‐pyramidal signs. A high index of suspicion is required to make an early diagnosis. We describe a middle‐aged Indian male with ALSP. A 53‐year‐old army veteran with a history of systemic hypertension presented with long‐standing and progressive cognitive decline. He had developed progressive memory impairment, wandering, aggressive behavior, difficulty walking on uneven ground, burning sensation in the feet, bowel–bladder abnormalities, and new onset gustatory facial hyperhidrosis for the past five years. As he was unable to carry out his duties, he resigned and pursued another career. However, he was unable to cope with the demands of his new job and had to resign again. He had six healthy brothers and there were no similar family complaints.