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A 4-year-old girl presented with increasing falls and progressive limb stiffness noticed for 2 months. There was no history of cognitive decline, seizures, or vision impairment. Examination revealed spastic quadriparesis, with no sensory or cerebellar abnor-malities. A suggestive MRI scan of the brain (figure) and reduced galactocerebrosidase activity in leuko-cytes confirmed the diagnosis of late-onset Krabbe disease. MRI in late-onset Krabbe disease classi-cally shows parieto-occipital periventricular white matter and posterior corpus callosal signal changes with sparing of subcortical U fibers and cerebellar white matter.1 Isolated corticospinal tract involve-ment is an unusual pattern described in adult- and late-onset forms of Krabbe disease.1 In the setting of childhood neurodegeneration, similar changes have also been described in X-linked adrenoleu-kodystrophy, acyl – coenzyme A (CoA) oxidase deficiency, and 3-hydroxy-3-methylglutaryl–CoA lyase deficiency.2,3 AUTHOR CONTRIBUTIONS R.S., S.S., and N.S. did the clinical/diagnostic workup of the child and reviewed the literature. A.K. provided neuroradiologic inputs. R.S., S.S., N.S., A.K., and S.G. contributed to the content of the manu-script. S.G. was in charge of the case overall and provided final ap-proval of the manuscript