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To the Editor:
We read with interest the article by Rajput et al.,1 who reported a patient with essential tremor (ET) whose clinical features were modified by a cerebellar hemorrhage. Their report highlights the important role of structural changes in the cerebellum in ET. We would like to address several points.
First, the postmortem changes documented in several recent ET series have not been restricted to Purkinje cell (PC) loss.2,3 In our series of 33 ET brains—including 5 provided by the Royal University Hospital brain bank—75.8% demonstrated abnormalities in the cerebellum compared to age-matched controls on postmortem examination.3 Abnormalities included PC loss and a sixfold to sevenfold increase in PC axonal swellings (torpedoes) and PC heterotopia (PCs displaced into the molecular layer) …
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