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<meta name="DC.Title" content="“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5935" />
<meta name="DC.Date" content="2019-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2019 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The “ears of the lynx” MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the spatacsin vesicle trafficking associated gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics.

MATERIALS AND METHODS: Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis.

RESULTS: The interrater reliability for FLAIR images was substantial (Cohen κ, 0.66–0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9).

CONCLUSIONS: The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.

AUC
:   area under the curve
HSP-TCC
:   hereditary spastic paraplegia with a thin corpus callosum
ROC
:   receiver operating characteristic curve" />
<meta name="DC.Contributor" content="B. Pascual" />
<meta name="DC.Contributor" content="S.T. de Bot" />
<meta name="DC.Contributor" content="M.R. Daniels" />
<meta name="DC.Contributor" content="M.C. França" />
<meta name="DC.Contributor" content="C. Toro" />
<meta name="DC.Contributor" content="M. Riverol" />
<meta name="DC.Contributor" content="P. Hedera" />
<meta name="DC.Contributor" content="M.T. Bassi" />
<meta name="DC.Contributor" content="N. Bresolin" />
<meta name="DC.Contributor" content="B.P. van de Warrenburg" />
<meta name="DC.Contributor" content="B. Kremer" />
<meta name="DC.Contributor" content="J. Nicolai" />
<meta name="DC.Contributor" content="P. Charles" />
<meta name="DC.Contributor" content="J. Xu" />
<meta name="DC.Contributor" content="S. Singh" />
<meta name="DC.Contributor" content="N.J. Patronas" />
<meta name="DC.Contributor" content="S.H. Fung" />
<meta name="DC.Contributor" content="M.D. Gregory" />
<meta name="DC.Contributor" content="J.C. Masdeu" />
<meta name="article:published_time" content="2019-01-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The “ears of the lynx” MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the &lt;i&gt;spatacsin vesicle trafficking associated&lt;/i&gt; gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The interrater reliability for FLAIR images was substantial (Cohen κ, 0.66–0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.&lt;/p&gt;" />
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<meta name="citation_author" content="B. Pascual" />
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<meta name="citation_author" content="S.T. de Bot" />
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<meta name="citation_author" content="M.R. Daniels" />
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<meta name="citation_reference" content="citation_journal_title=Neurology;citation_journal_abbrev=Neurology;citation_author=C. Goizet;citation_author=A. Boukhris;citation_author=D. Maltete;citation_title=SPG15 is the second most common cause of hereditary spastic paraplegia with thin corpus callosum;citation_pages=1111-1119;citation_volume=73;citation_year=2009;citation_issue=14;citation_pmid=19805727;citation_doi=10.1212/WNL.0b013e3181bacf59" />
<meta name="citation_reference" content="citation_journal_title=Annals of neurology;citation_journal_abbrev=Ann Neurol;citation_author=U. Hehr;citation_author=P. Bauer;citation_author=B. Winner;citation_title=Long-term course and mutational spectrum of spatacsin-linked spastic paraplegia.;citation_pages=656-665;citation_volume=62;citation_year=2007;citation_issue=6;citation_pmid=18067136;citation_doi=10.1002/ana.21310" />
<meta name="citation_reference" content="citation_journal_title=Brain;citation_author=E. Kara;citation_author=A. Tucci;citation_author=C. Manzoni;citation_title=Genetic and phenotypic characterization of complex hereditary spastic paraplegia;citation_volume=139;citation_year=2016;citation_pmid=27217339;citation_doi=10.1093/brain/aww111" />
<meta name="citation_reference" content="citation_journal_title=Brain;citation_author=V. Pensato;citation_author=B. Castellotti;citation_author=C. Gellera;citation_title=Overlapping phenotypes in complex spastic paraplegias SPG11, SPG15, SPG35 and SPG48;citation_volume=137;citation_year=2014;citation_pmid=24833714;citation_doi=10.1093/brain/awu121" />
<meta name="citation_reference" content="citation_journal_title=Brain;citation_author=SPATAX consortium;citation_title=Mutations in SPG11 are frequent in autosomal recessive spastic paraplegia with thin corpus callosum, cognitive decline and lower motor neuron degeneration;citation_volume=131;citation_year=2008;citation_pmid=18079167;citation_doi=10.1093/brain/awm293" />
<meta name="citation_reference" content="citation_journal_title=Brain;citation_author=A. Estrada-Cuzcano;citation_author=S. Martin;citation_author=T. Chamova;citation_title=Loss-of-function mutations in the ATP13A2/PARK9 gene cause complicated hereditary spastic paraplegia (SPG78);citation_volume=140;citation_year=2017;citation_pmid=28137957;citation_doi=10.1093/brain/aww307" />
<meta name="citation_reference" content="citation_journal_title=Handb Clin Neurol;citation_author=F. Eichler;citation_author=E. Ratai;citation_author=JJ. Carroll;citation_title=Inherited or acquired metabolic disorders;citation_pages=603-36;citation_volume=135;citation_year=2016;citation_pmid=27432685;citation_doi=10.1016/B978-0-444-53485-9.00029-" />
<meta name="citation_reference" content="citation_journal_title=Clin Genet;citation_author=MS. Abdel-Hamid;citation_author=MY. Issa;citation_author=GA. Otaify;citation_title=PGAP3-related hyperphosphatasia with mental retardation syndrome: report of 10 new patients and a homozygous founder mutation;citation_pages=84-91;citation_volume=93;citation_year=2018;citation_pmid=28390064;citation_doi=10.1111/cge.13033" />
<meta name="citation_reference" content="citation_journal_title=Pediatr Neurol;citation_author=R. Barmherzig;citation_author=G. Bullivant;citation_author=D. Cordeiro;citation_title=A new patient with intermediate severe Salla disease with hypomyelination: a literature review for Salla disease;citation_pages=87-91.e82;citation_volume=74;citation_year=2017;citation_pmid=28662915;citation_doi=10.1016/j.pediatrneurol.2017.05.022" />
<meta name="citation_reference" content="citation_journal_title=Hum Genet;citation_author=C. Depienne;citation_author=C. Nava;citation_author=B. Keren;citation_title=Genetic and phenotypic dissection of 1q43q44 microdeletion syndrome and neurodevelopmental phenotypes associated with mutations in ZBTB18 and HNRNPU;citation_pages=463-79;citation_volume=136;citation_year=2017;citation_pmid=28283832;citation_doi=10.1007/s00439-017-1772-0" />
<meta name="citation_reference" content="citation_journal_title=Am J Hum Genet;citation_author=E. Flex;citation_author=M. Niceta;citation_author=S. Cecchetti;citation_title=Biallelic mutations in TBCD, encoding the tubulin folding cofactor D, perturb microtubule dynamics and cause early-onset encephalopathy;citation_pages=962-73;citation_volume=99;citation_year=2016;citation_pmid=27666370;citation_doi=10.1016/j.ajhg.2016.08.003" />
<meta name="citation_reference" content="citation_journal_title=Clin Genet;citation_author=H. Kurata;citation_author=H. Terashima;citation_author=M. Nakashima;citation_title=Characterization of SPATA5-related encephalopathy in early childhood;citation_pages=437-44;citation_volume=90;citation_year=2016;citation_pmid=27246907;citation_doi=10.1111/cge.12813" />
<meta name="citation_reference" content="citation_journal_title=Am J Hum Genet;citation_author=IJC. Lamers;citation_author=MR. Reijnders;citation_author=H. Venselaar;citation_title=Recurrent de novo mutations disturbing the GTP/GDP binding pocket of RAB11B cause intellectual disability and a distinctive brain phenotype;citation_pages=824-32;citation_volume=101;citation_year=2017;citation_pmid=29106825;citation_doi=10.1016/j.ajhg.2017.09.015" />
<meta name="citation_reference" content="citation_journal_title=Am J Med Genet A;citation_author=L. Meng;citation_author=T. Donti;citation_author=F. Xia;citation_title=Homozygous variants in pyrroline-5-carboxylate reductase 2 (PYCR2) in patients with progressive microcephaly and hypomyelinating leukodystrophy;citation_pages=460-70;citation_volume=173;citation_year=2017;citation_pmid=27860360;citation_doi=10.1002/ajmg.a.38049" />
<meta name="citation_reference" content="citation_journal_title=Am J Med Genet A;citation_author=RO. Rosti;citation_author=E. Dikoglu;citation_author=MS. Zaki;citation_title=Extending the mutation spectrum for Galloway-Mowat syndrome to include homozygous missense mutations in the WDR73 gene;citation_pages=992-98;citation_volume=170A;citation_year=2016;citation_pmid=27001912;citation_doi=10.1002/ajmg.a.37533" />
<meta name="citation_reference" content="citation_journal_title=Pediatr Neurol;citation_author=M. Sidhu;citation_author=L. Brady;citation_author=M. Tarnopolsky;citation_title=Clinical manifestations associated with the N-Terminal-Acetyltransferase NAA10 gene mutation in a girl: Ogden syndrome;citation_pages=82-85;citation_volume=76;citation_year=2017;citation_pmid=28967461;citation_doi=10.1016/j.pediatrneurol.2017.07.010" />
<meta name="citation_reference" content="citation_journal_title=Brain;citation_author=MF. Kraus;citation_author=T. Susmaras;citation_author=BP. Caughlin;citation_title=White matter integrity and cognition in chronic traumatic brain injury: a diffusion tensor imaging study;citation_volume=130;citation_year=2007;citation_pmid=17872928;citation_doi=10.1093/brain/awm216" />
<meta name="citation_reference" content="citation_title=MRI Atlas of Human White Matter;citation_year=2005" />
<meta name="citation_reference" content="citation_journal_title=Journal of Neuroimaging;citation_journal_abbrev=J Neuroimaging;citation_author=M. Riverol;citation_author=L. Samaranch;citation_author=B. Pascual;citation_title=Forceps minor region signal abnormality &quot;ears of the lynx&quot;: an early MRI finding in spastic paraparesis with thin corpus callosum and mutations in the spatacsin gene (SPG11) on chromosome 15.;citation_pages=52-60;citation_volume=19;citation_year=2009;citation_issue=1;citation_pmid=19040626;citation_doi=10.1111/j.1552-6569.2008.00327.x" />
<meta name="citation_reference" content="citation_journal_title=American Journal of Roentgenology;citation_journal_abbrev=Am. J. Roentgenol.;citation_author=G. Sze;citation_author=SJ. De Armond;citation_author=M. Brant-Zawadzki;citation_title=Foci of MRI signal (pseudo lesions) anterior to the frontal horns: histologic correlations of a normal finding;citation_pages=331-337;citation_volume=147;citation_year=1986;citation_issue=2;citation_pmid=3487952;citation_doi=10.2214/ajr.147.2.331" />
<meta name="citation_reference" content="citation_journal_title=Eur J Hum Genet;citation_author=ST. de Bot;citation_author=RC. Burggraaff;citation_author=JC. Herkert;citation_title=Rapidly deteriorating course in Dutch hereditary spastic paraplegia type 11 patients;citation_pages=1312-15;citation_volume=21;citation_year=2013;citation_pmid=23443022;citation_doi=10.1038/ejhg.2013.27" />
<meta name="citation_reference" content="citation_journal_title=Movement disorders :  official journal of the Movement Disorder Society;citation_journal_abbrev=Mov Disord;citation_author=MC. França;citation_author=A. D'Abreu;citation_author=CV. Maurer-Morelli;citation_title=Prospective neuroimaging study in hereditary spastic paraplegia with thin corpus callosum.;citation_pages=1556-1562;citation_volume=22;citation_year=2007;citation_issue=11;citation_pmid=17516453;citation_doi=10.1002/mds.21480" />
<meta name="citation_reference" content="citation_journal_title=Research in nursing &amp; health;citation_journal_abbrev=Res Nurs Health;citation_author=MA. Hertzog;citation_title=Considerations in determining sample size for pilot studies.;citation_pages=180-191;citation_volume=31;citation_year=2008;citation_issue=2;citation_pmid=18183564;citation_doi=10.1002/nur.20247" />
<meta name="citation_reference" content="citation_journal_title=Biometrics;citation_journal_abbrev=Biometrics;citation_author=JR. Landis;citation_author=GG. Koch;citation_title=The measurement of observer agreement for categorical data.;citation_pages=159-174;citation_volume=33;citation_year=1977;citation_issue=1;citation_pmid=843571;citation_doi=10.2307/2529310" />
<meta name="citation_reference" content="citation_journal_title=Nature genetics;citation_journal_abbrev=Nat Genet;citation_author=G. Stevanin;citation_author=FM. Santorelli;citation_author=H. Azzedine;citation_title=Mutations in SPG11, encoding spatacsin, are a major cause of spastic paraplegia with thin corpus callosum.;citation_pages=366-372;citation_volume=39;citation_year=2007;citation_issue=3;citation_pmid=17322883;citation_doi=10.1038/ng1980" />
<meta name="citation_reference" content="citation_journal_title=Arq Neuropsiquiatr;citation_author=I. Faber;citation_author=KR. Servelhere;citation_author=ARM. Martinez;citation_title=Clinical features and management of hereditary spastic paraplegia;citation_pages=219-26;citation_volume=72;citation_year=2014;citation_pmid=24676440;citation_doi=10.1590/0004-282X20130248" />
<meta name="citation_reference" content="citation_journal_title=Ann Clin Transl Neurol;citation_author=B. Renvoisé;citation_author=J. Chang;citation_author=R. Singh;citation_title=Lysosomal abnormalities in hereditary spastic paraplegia types SPG15 and SPG11;citation_pages=379-89;citation_volume=1;citation_year=2014;citation_pmid=24999486;citation_doi=10.1002/acn3.64" />
<meta name="citation_reference" content="citation_journal_title=J Neurol;citation_author=MP. Giannoccaro;citation_author=R. Liguori;citation_author=A. Arnoldi;citation_title=Atypical late-onset hereditary spastic paraplegia with thin corpus callosum due to novel compound heterozygous mutations in the SPG11 gene;citation_pages=1825-27;citation_volume=261;citation_year=2014;citation_pmid=25059394;citation_doi=10.1007/s00415-014-7443-3" />
<meta name="citation_reference" content="citation_journal_title=Neurodegener Dis;citation_author=MJ. Fraidakis;citation_author=M. Brunetti;citation_author=C. Blackstone;citation_title=Novel compound heterozygous spatacsin mutations in a Greek kindred with hereditary spastic paraplegia SPG11 and dementia;citation_pages=373-81;citation_volume=16;citation_year=2016;citation_pmid=27318863;citation_doi=10.1159/000444715" />
<meta name="citation_reference" content="citation_journal_title=J Neurol;citation_author=S. Chakrabarty;citation_author=N. Vijayakumar;citation_author=K. Radhakrishnan;citation_title=Spastizin mutation in hereditary spastic paraplegia with thin corpus callosum;citation_pages=2130-32;citation_volume=263;citation_year=2016;citation_pmid=27544497;citation_doi=10.1007/s00415-016-8258-1" />
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<meta name="twitter:title" content="“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The “ears of the lynx” MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the spatacsin vesicle trafficking associated gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics.

MATERIALS AND METHODS: Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis.

RESULTS: The interrater reliability for FLAIR images was substantial (Cohen κ, 0.66–0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9).

CONCLUSIONS: The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.

AUC
:   area under the curve
HSP-TCC
:   hereditary spastic paraplegia with a thin corpus callosum
ROC
:   receiver operating characteristic curve" />
<meta name="og-title" property="og:title" content="“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/40/1/199" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The “ears of the lynx” MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the spatacsin vesicle trafficking associated gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics.

MATERIALS AND METHODS: Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis.

RESULTS: The interrater reliability for FLAIR images was substantial (Cohen κ, 0.66–0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9).

CONCLUSIONS: The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.

AUC
:   area under the curve
HSP-TCC
:   hereditary spastic paraplegia with a thin corpus callosum
ROC
:   receiver operating characteristic curve" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node65264--5" data-node-nid="65264" id="top-node-65264--61103701192" data-pisa="ajnr;40/1/199" data-pisa-master="ajnr;ajnr.A5935" data-apath="/ajnr/40/1/199.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Pediatrics</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">B. Pascual</span>, <span class="highwire-citation-author" data-delta="1">S.T. de Bot</span>, <span class="highwire-citation-author" data-delta="2">M.R. Daniels</span>, <span class="highwire-citation-author" data-delta="3">M.C. França</span>, <span class="highwire-citation-author" data-delta="4">C. Toro</span>, <span class="highwire-citation-author" data-delta="5">M. Riverol</span>, <span class="highwire-citation-author" data-delta="6">P. Hedera</span>, <span class="highwire-citation-author" data-delta="7">M.T. Bassi</span>, <span class="highwire-citation-author" data-delta="8">N. Bresolin</span>, <span class="highwire-citation-author" data-delta="9">B.P. van de Warrenburg</span>, <span class="highwire-citation-author" data-delta="10">B. Kremer</span>, <span class="highwire-citation-author" data-delta="11">J. Nicolai</span>, <span class="highwire-citation-author" data-delta="12">P. Charles</span>, <span class="highwire-citation-author" data-delta="13">J. Xu</span>, <span class="highwire-citation-author" data-delta="14">S. Singh</span>, <span class="highwire-citation-author" data-delta="15">N.J. Patronas</span>, <span class="highwire-citation-author" data-delta="16">S.H. Fung</span>, <span class="highwire-citation-author" data-delta="17">M.D. Gregory</span> and <span class="highwire-citation-author" data-delta="18">J.C. Masdeu</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2019,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">199-203; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5935 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-65264--61103701192" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">B. Pascual </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (B.P., M.R.D., J.C.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.%2BPascual%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pascual%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.%2BPascual%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4467-7406" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B. Pascual</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.T. de Bot </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurology (S.T.d.B.), Leiden University Medical Centre, Leiden, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.T.%2Bde%2BBot%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=de%20Bot%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.T.%2Bde%2BBot%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3512-2468" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.T. de Bot</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.R. Daniels </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurology (B.P., M.R.D., J.C.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.R.%2BDaniels%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Daniels%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.R.%2BDaniels%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4924-2644" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.R. Daniels</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M.C. França <span class="nlm-suffix">Jr</span></div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurology (M.C.F.), University of Campinas, Campinas, Brazil</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.C.%2BFran%C3%A7a%2B%3Cspan%2Bclass%3D%22nlm-suffix%22%3EJr%3C/span%3E" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fran%C3%A7a%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.C.%2BFran%25C3%25A7a%2BJr" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0898-2419" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.C. França <span class="nlm-suffix">Jr</span></a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">C. Toro </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>National Institutes of Health Intramural Research Program (C.T., N.J.P., M.D.G.), Bethesda, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BToro%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Toro%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BToro%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7139-0518" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Toro</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M. Riverol </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Neurology (M.R.), Clínica Universidad de Navarra, Pamplona, Spain</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BRiverol%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Riverol%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BRiverol%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4383-9127" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Riverol</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">P. Hedera </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>h</span>Department of Neurology (P.H.), Vanderbilt University Medical Center, Nashville, Tennessee</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BHedera%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hedera%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BHedera%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2699-4085" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Hedera</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">M.T. Bassi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>i</span>Laboratory of Molecular Biology (M.T.B.), Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico E. Medea, Bosisio Parini, Lecco, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.T.%2BBassi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bassi%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.T.%2BBassi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8236-1197" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.T. Bassi</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">N. Bresolin </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>j</span>Department of Neuroscience and Mental Health (N.B.), University Hospital Policlinico Ca'Granda, University of Milan, Milan, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BBresolin%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bresolin%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BBresolin%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6694-3595" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Bresolin</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">B.P. van de Warrenburg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>k</span>Department of Neurology (B.P.v.d.W.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.P.%2Bvan%2Bde%2BWarrenburg%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=van%20de%20Warrenburg%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.P.%2Bvan%2Bde%2BWarrenburg%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4412-1616" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.P. van de Warrenburg</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">B. Kremer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>l</span>Department of Neurology (B.K.), University Medical Center Groningen, Groningen, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.%2BKremer%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kremer%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.%2BKremer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6569-2955" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B. Kremer</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">J. Nicolai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>m</span>Department of Neurology (J.N.), Maastricht University Medical Centre, Maastricht, the Netherlands</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BNicolai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nicolai%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BNicolai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4480-4583" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Nicolai</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">P. Charles </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>n</span>Department of Genetics (P.C.), Hôpital Pitié-Salpêtrière, Paris, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BCharles%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Charles%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BCharles%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3108-2171" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Charles</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">J. Xu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Biostatistics (J.X.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BXu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Xu%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BXu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3463-2327" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Xu</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">S. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 40</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 1 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jan 2019 </div></div>
      
      
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      <div class="highwire-cite-title">“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Pascual</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.T.</span> <span class="nlm-surname">de Bot</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.R.</span> <span class="nlm-surname">Daniels</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">França</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Toro</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Riverol</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Hedera</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.T.</span> <span class="nlm-surname">Bassi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Bresolin</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">B.P.</span> <span class="nlm-surname">van de Warrenburg</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Kremer</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Nicolai</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Charles</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Xu</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Singh</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">N.J.</span> <span class="nlm-surname">Patronas</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-given-names">S.H.</span> <span class="nlm-surname">Fung</span></span>, <span class="highwire-citation-author" data-delta="17"><span class="nlm-given-names">M.D.</span> <span class="nlm-surname">Gregory</span></span>, <span class="highwire-citation-author" data-delta="18"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Masdeu</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">199-203; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5935 </span></div>
  
  
  
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      <div class="highwire-cite-title">“Ears of the Lynx” MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Pascual</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.T.</span> <span class="nlm-surname">de Bot</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.R.</span> <span class="nlm-surname">Daniels</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">França</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Toro</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Riverol</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Hedera</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.T.</span> <span class="nlm-surname">Bassi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Bresolin</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">B.P.</span> <span class="nlm-surname">van de Warrenburg</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Kremer</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Nicolai</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Charles</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Xu</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Singh</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">N.J.</span> <span class="nlm-surname">Patronas</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-given-names">S.H.</span> <span class="nlm-surname">Fung</span></span>, <span class="highwire-citation-author" data-delta="17"><span class="nlm-given-names">M.D.</span> <span class="nlm-surname">Gregory</span></span>, <span class="highwire-citation-author" data-delta="18"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Masdeu</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">199-203; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5935 </span></div>
  
  
  
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