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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 17A0 Case 17 History
Case 17 History The patient was a 70yo female with a 20 year history of progressive neurological decline, hypertension and tobacco use. Her neurologic process began in 1984 with slurred speech, and numbness of L arm and leg, presumed to be due to a stroke. She became confused in 1993 but recovered following carotid endarterectomy. She returned in 1997 with a clumsy gait and memory deficits. At that time, she had wide based gait, weakness of right leg and hyperreflexia on the right. An MRI showed periventricular white matter changes and a lacunar infarct in the right pons. In 1998 her neurologic exam additionally showed nystagmus and ocular flutter. An MRI performed at that time showed no interval changes. A lumbar puncture was negative for oligoclonal bands, protein 51, Glucose 80, 0 cells, 14-3-3 protein negative. Paraneoplastic antibodies were negative (Purkinje cytoplasmic antibody PCA-1 neg). A chest CT was negative. She did not respond to steroids or coumadin. When last seen in 1999, she was wheelchair bound, oriented to person, place, and time but had difficulty with abstraction, had downbeat nystagmus, a weak gag reflex, resting tremor, dysmetria (L > R) and marked truncal ataxia. She died in a nursing home.
