Table of Contents
Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 12A0 Case 12 History
Case 12 History ---- The patient was a 61yo female with a history of symptoms beginning in approximately 2008. At that time, she was found to have primary hyperparathyroidism with osteoporosis, treated with adenoma resection in 2009. In 2012, she noticed balance issues and lightheadedness, with associated falls upon standing, associated with low blood pressure. She also experienced weakness while walking, a cold/numb sensation in her legs, and difficulty with handwriting. MRI in January 2012 showed only small vessel disease. Physical examination showed decreased temperature sensation in the distal lower extremities, a significant drop in blood pressure from sitting to standing, exaggerated reflexes with cogwheel rigidity on the right and decreased amplitude of repetitive finger movements, both greater on the right as compared to the left. At that time, it was thought the patient had a combination of parkinsonian symptoms and autonomic neuropathy, possibly multisystem atrophy. In 10/2013, she was noted to have increased falls although she was being treated with midodrine for orthostatic hypotension. Her incontinence had worsened, but this was present after a hysterectomy and bladder surgery. She developed worsening difficulty speaking and communicating effectively. By 05/2014, she began the process of moving to an assisted living facility due to her inability to cook, walk, and take care of herself. She was dependent on a walker, and had a softer voice, swallowing problems including choking on liquids, severe constipation, difficulty urinating, incontinence, orthostatic hypotension, ataxia, numbness and tingling throughout her body. At her final office visit in 8/2014, she was thought to have stage 4 Parkinsonism and probable multiple system atrophy with autonomic failure, with a combination of bradykinesia, rigidity, ataxia, and impaired postural reflexes with a poor response to Sinemet. She was placed in hospice care in 02/2015.
