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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 4A0 Case 4 History
Case 4 History
This 82yo female first noticed right hand shaking at age 69 years with micrographia, slower walking, reduced arm swing, softer voice and tremor. By age 72, her left hand shook at rest and she developed constipation. Her symptoms initially seemed to improve with pramipexole. Over the years, parkinsonism increased in severity. She continued to have reasonable response to levodopa, developed wearing off, freezing, dyskinesias, bladder incontinence but no orthostasis. She had a distal small fiber peripheral neuropathy with pain and numbness in the feet. In the last two years, benefit from individual doses of levodopa was less prominent; postural stability worsened; she mostly used a wheelchair; cognition began to deteriorate (in the last 1.5 years). She had multiple falls. MMSE last done at ~80yo was 29/30; however, she clearly developed more trouble with orientation by 2010 with difficulty recalling the day of the week, difficulty reading and concentration but no excessive daytime sleepiness. There were no hallucinations, no problems with names or losing items around the house but she made lots of notes. She scored 41 out of 108 on the UPDRS Subscale III (Motor Examination). The final clinical diagnostic differential was Idiopathic Parkinson Disease vs. Multiple system atrophy (striatonigral degeneration type)
