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Diagnostic criteria of multiple system atrophy
  1. Department of Neuropathology, Institute of Psychiatry
  2. De Crespigny Park, Denmark Hill
  3. London SE5 8AF, UK
  1. npath{at}

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I think that the correspondence concerning diagnostic criteria for corticobasal degeneration and the specificity of glial cytoplasmic inclusions1 should not be closed, as the reply by Xuereb and Hodges contains a somewhat misleading statement concerning the diagnosis of multiple system atrophy (MSA). In fact there was a consensus statement on the diagnosis of MSA,2establishing three diagnostic categories reflecting differing levels of certainty: definite, probable, and possible. Its conclusion is that “the diagnosis of definite MSA can only be made after a neuropathological examination of the CNS disclosing the characteristic density and distribution of glial cytoplasmic inclusions” in association with degenerative changes. Thus the presence of glial cytoplasmic inclusions is not confirmatory evidence, but the hallmark lesion of MSA.


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