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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 11A0 Case 11 History
Case 11 History ---- The patient was first evaluated at the MDC in August 2002. At that time, she was a 32yo female with a complaint of left hand tremor. Her motor problems began one year earlier, at age 31 years, with shaking of the left index finger. She had a non-contrast MRI which was normal. There was no family history of motor disorder. Her mental status was unremarkable. Cranial nerves were normal. There was some rigidity in her left upper extremity. There were no fasciculations but there was some bradykinesia. Her clinical diagnosis in 2002 was idiopathic Parkinson's disease (stage 1.5) characterized by asymmetric onset of rest/action tremor and bradykinesias. She delivered a healthy baby in May 2005. At age 36 years, in 2006, she had motor fluctuations and dyskinesias that progressed to become severe in 2006. Her dyskinesias caused recurrent falls. Her mental status was unremarkable and she had no hallucinations, depression, or incontinence. She scored 16 out of 108 on the Motor Examination of the UPDRS Subscale III. She scored 30 out of 30 on the Mini-mental State Examination. The asymmetry of her symptoms, the presence of rest tremor, her initial definite response to levodopa and the absence of atypical features (such as prominent autonomic symptoms, cerebellar signs, long tract signs, and significant eye movement abnormalities) supported the diagnosis of idiopathic Parkinson's disease. In 2006, she had subthalamic deep brain stimulation surgery (STN DBS). Following surgery, there was only modest benefit from Sinemet and severe autonomic dysfunction. She had marked dyskinesias that impaired her function. She was mostly wheelchair-bound and, in addition to her parkinsonism, she had autonomic dysfunction, orthostatic hypotension, and symptoms of presyncope.
