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To the Editor: We read with interest the review by Gilman and Quinn on the relationship of multiple system atrophy (MSA) to sporadic olivopontocerebellar atrophy (sOPCA). [1] We are amazed, however, at the reluctance of neurologists to accept the support of MRI in diagnosing these conditions.
We agree that mild cerebellar and pontine atrophy may be of questionable significance and insufficient to establish a diagnosis. However, when in addition to atrophy of the cerebellum, pons, and middle cerebellar peduncles there are signal abnormalities in the structures known to degenerate in sOPCA, the diagnosis, in our opinion, becomes definite. In sOPCA the pontine nuclei and the fibers running from them to the cerebellum through the middle cerebellar peduncles (transverse pontine fibers) degenerate; so, too, do …
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