Multiple system atrophy in a man misdiagnosed with parkinsonism

Sasmith R. Menakuru; Mir Inzamam Ali; Mir Inzamam Ali; Sruti Kalla; Sruti Kalla; Abhinav Datti; Abhinav Datti

doi:10.18203/2320-6012.ijrms20204915

Authors

Sasmith R. Menakuru Department of Medicine, Narayana Medical College, Andra Prashesh, India
Mir Inzamam Ali Department of Medicine, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates
Mir Inzamam Ali Department of Medicine, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates
Sruti Kalla Department of Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
Sruti Kalla Department of Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
Abhinav Datti Department of Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
Abhinav Datti Department of Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20204915

Keywords:

Multiple System Atrophy, Parkinson's Disease

Abstract

Multiple system atrophy (MSA) is a rare sporadic, progressive, neurodegenerative disorder with autonomic deficits, with a yearly incidence of 0.000006%. MSA is often misdiagnosed as idiopathic Parkinson’s Disease (PD). It may present with a combination of parkinsonian, autonomic, and cerebellar signs. From a prognostic point of view, accurate diagnosis is essential. Our patient was misdiagnosed as having PD, but after thorough workup was diagnosed as having MSA type Parkinson’s. Because of this, the patient was put on supportive treatment for MSA. The authors strive to differentiate between the types of multiple system atrophy and its diagnostic criteria as well as differences between MSA and Parkinson’s.

Metrics

Metrics Loading ...

Author Biography

Sasmith R. Menakuru, Department of Medicine, Narayana Medical College, Andra Prashesh, India

Medical Student, Department of Internal Medicine

References

Jellinger KA. Multiple System Atrophy: An Oligodendroglioneural Synucleinopathy1. J Alzheimers Dis. 2018;62(3):1141‐79.

Ciolli L, Krismer F, Nicoletti F, Wenning GK. An update on the cerebellar subtype of multiple system atrophy. Cerebell Ataxia. 2014;1(1):1-2.

Koga S, Dickson DW. Recent advances in neuropathology, biomarkers and therapeutic approach of multiple system atrophy. J Neurol Neurosurg Psychiat. 2018;89(2):175-84.

Ben-Shlomo Y, Wenning GK, Tison F, Quinn NP. Survival of patients with pathologically proven multiple system atrophy: a meta-analysis. Neurol 1997;48:384–93.

Koga S, Aoki N, Uitti RJ, Van Gerpen JA, Cheshire WP, Josephs KA, Wszolek ZK, Langston JW, Dickson DW. When DLB, PD, and PSP masquerade as MSA: an autopsy study of 134 patients. Neurol. 2015;85(5):404-12.

Murphy MA, Friedman JH, Tetrud JW, Factor SA. Neurodegenerative disorders mimicking progressive supranuclear palsy: a report of three cases. J Clin Neurosci. 2005;12:941.

Cheshire WP. Highlights in clinical autonomic neurosciences: Clinical update on multiple system atrophy. Auton Neurosci. 2014;186:5-7.

Laurens B, Vergnet S, Lopez MC, Foubert-Samier A, Tison F, Fernagut PO, Meissner WG. Multiple system atrophy-state of the art. C Neurol Neurosci Report. 2017;17(5):41.

Gilman S, Low P, Quinn N, Albanese A, Ben-Shlomo Y, Fowler C, et al. Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology. Clin Auton Res. 1998;8:359.

Palace J, Chandiramani VA, Fowler CJ. Value of sphincter electromyography in the diagnosis of multiple system atrophy. Muscle Nerve. 1997; 20:1396.

Geser F, Seppi K, Stampfer-Kountchev M, Köllensperger M, Diem A, Ndayisaba JP, et al. The European multiple system atrophy-study group (EMSA-SG). Journal of neural transmission. 2005;112(12):1677-86.

Yabe I, Soma H, Takei A, Fujiki N, Yanagihara T, Sasaki H. MSA-C is the predominant clinical phenotype of MSA in Japan: analysis of 142 patients with probable MSA. J Neurol Sci. 2006;249:115–21.

Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Dürr A, Fowler CJ, Kaufmann H. Second consensus statement on the diagnosis of multiple system atrophy. Neurol. 2008;71(9):670-6.

Wenning GK, Shlomo YB, Magalhaes M, Danie SE, Quinn NP. Clinical features and natural history of multiple system atrophy: an analysis of 100 cases. Bra. 1994;117(4):835-45.

O'Sullivan SS, Massey LA, Williams DR, Silveira-Moriyama L, Kempster PA, Holton JL, et al. Clinical outcomes of progressive supranuclear palsy and multiple system atrophy. Brain. 2008;131(5):1362-72.

Petrovic IN, Ling H, Asi Y, Ahmed Z, Kukkle PL, Hazrati LN, et al. Multiple system atrophy–parkinsonism with slow progression and prolonged survival: a diagnostic catch. Movement disorders. 2012;27(9):1186-90.

Palma JA, Kaufmann H. Novel therapeutic approaches in multiple system atrophy. Clin Auton. 2015;25:37.

Ghrist DG, Brown GE. Postural hypertension with syncope: Its successful treatment with ephedrine. Am J Med Sci. 1928;175:336.

Maab S, Levin J, Höglinger G. Current Treatment of Multiple System Atrophy. Curr Treat Opt Neurol. 2016;18:51.

Kawai, M. Suenaga, A. Takeda, M. Ito, H. Watanabe, F. Tanaka, K. et al. Neurol. 2008;70(16 Part 2)1390-6.

Wenning GK, Colosimo C, Geser F, Poewe W. Multiple system atrophy. Lanc Neurol. 2004;3:93.

Hughes AJ, Colosimo C, Kleedorfer B, Daniel SE, Lees AJ. The dopaminergic response in multiple system atrophy. J Neurol Neurosurg Psychiat. 1992;55(11):1009-13.