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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 13A0 Case 13 History
Case 13 History ---- The patient was a 57yo male with a history of multisystem atrophy with Parkinsonism, stage 4, chronic sacral decubiti, bilateral lower extremity deep venous thrombosis, and coronary artery disease. The patient was first diagnosed with parkinsonism in October 2001. At that time he complained of a 3 month history of a shuffling gait and difficulty with his handwriting. He was started on pramipexole at that time with some clinical improvement. However, in the spring of 2002, his wife noted a decrease in his facial expression and that he had a slight tremor in his right hand. In May of 2002, Sinemet and Amantadine were added to his medicine regimen. By November of 2002, he was noted to have reduced shuffling. He also complained of back pain that was believed most likely do to his abnormal posture secondary to his parkinsonism. In May 2003, he was still complaining of lower back pain and difficulty walking and increased rigidity was noted in the neck, bilateral upper and lower extremities with monotone speech and moderate hypomimia. He also complained of bladder and bowel dysfunction. At that time his parkinsonism was stage 4, increased from prior stage 2 disease with concern for multisystem atrophy. At that time, his Sinemet dosage was increased. In November 2003, he continued to have postural abnormalities, requiring a walker for ambulation. He also complained of episodic lightheadedness. He continued to have bladder and bowel dysfunction. He also complained of some dysphagia. His diagnosis was changed at that time to multisystem atrophy with parkinsonism. He continued on Sinemet, pramipexole and amantadine. In June 2004, the patient had worsening of balance, postural abnormalities, tinnitus and distortion of visual images "like a matte filter was applied." The patient's diagnosis remained as MSA with parkinsonism. No other clinical information prior to the time of death was available.
