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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 16A0 Case 16 History
Case 16 History
This 63yo female was first seen in the MDC at age 60. In 2003 (age 50), she started acting out her dreams. In 2007 at age 54, she had increased urinary frequency. At age 56, she began to stumble with right foot dragging. Later that year, she had twitching of the right little finger. By age 58, she had increase shuffling and by age 59 had balance problems. She started falling at age 60. Her speech became softer. She had some mild forgetfulness. She became depressed and responded to escitalopram. She felt lightheaded but mostly in the summer. Her symptoms improved with rasagiline and pramipexole but she had more benefit with levodopa. She developed dyskinesias with relatively low doses of levodopa and this limited her dosing. She was found to have ocular overshoot on that initial exam. Her cognitive performance and memory improved after stopping dopamine agonists. Tremor and balance worsened over the next couple of years but thinking remained good. Low mood required adjustments of antidepressants. She continued to have some orthostasis. Response to levodopa remained modest but she still had some end of dose dyskinesias. By age 62, she needed full time care and bladder catheterization. She needed help with all transfers. Her voice became softer. Dyskinesias remained mild and she continued to have some mild REM behavior problems. Constipation became more severe. Speech was markedly impaired by age 62-63. At age 63 she developed visual hallucinations. She continued to have full range of eye movements but with square wave jerks. She subsequently developed swallowing problems and died of dehydration and inanition.
