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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 14A0 Case 14 History
Case 14 History ---- This 78yo female first developed a slowness in the right hand. Handwriting became smaller and then steps also became smaller. She felt muscle stiffness in the muscles and particularly in the right shoulder and neck. Her right arm did not swing as well when walking. About age 82, she developed some imbalance and then some freezing when walking through doorways, some start hesitation when in crowds. She was slower arising from a deep chair. She fell at age 81 and began using a walker. She was slower rolling in bed. Dressing was much slower but remained independent. Her voice became quieter requiring her to repeat. Others noticed that her face was masked. In the last couple of years, she had some choking on liquids and excessive drooling. She had bladder urgency and used adult diapers at night. She had constipation but no stool incontinence. She did have depression with anxiety that was well treated with sertraline. Low dose levodopa provided modest benefit. She had some excessive daytime sleepiness (but no sleep attacks), orthostasis, dyskinesia, hallucinations or nausea. There was no REM behavior disorder symptoms. No dementia, despite an MMSE = 22/30; she was clearly a CDR=0 and the family confirmed her cognitive function. She started falling more in the last several months and was admitted to an OSH in January 2014 after a fall with a broken pelvis. She subsequently developed pneumonia. She did not have MRSA but was treated with antibiotics Zosyn and Cipro for the last week of her life. Upon removing a central line, she probably had a pulmonary embolus. She was 84 years old when she died and her clinical cause of death was pneumonia with a possible pulmonary embolus.
