LAUSR

I read with interest Galit Kleiner and colleagues ’ report of a 79-year-old man suffering from progressive hemichorea, spasticity, and a frontal behavioral syndrome, with thrombocytopenia and positive antiphospholipid antibodies. 1 Rationally, antiphospholipid antibody syndrome (aPS) was the antemortem diagnosis. However, brain autopsy revealed a pattern of tau aggregation diagnostic of the pallidonigroluysian atrophy (PNLA) variant of progressive supranuclear palsy (PSP). The authors concluded that aPS must have been a red herring. Is neuropathology always the fi nal diagnosis? If so, was chorea also a red herring? Will any entity ever cease to expand if held to a pathology gold standard? Will the differential between hyper-and hypokinetic movement disorders remain negotiable pending a pathology report?