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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 5A0 Case 5 History
Case 5 History ---- The patient was a 74yo female followed in the WUMDC since March 1997 (71yo) with a diagnosis of Shy-Drager Syndrome/MSA. Her symptoms began in 1994 with overflow urinary incontinence and worsening constipation. In 1995 she had several episodes of syncope and was found to have significant orthostatic hypotension (Rx Florinef) with a modest improvement. In 1995 she began having mild but progressive parkinsonism, i.e. rest tremor, hypophonic speech, micrographia, and gait difficulty (Amantadine was no help). When first seen in 1997 exam revealed rigidity, bradykinesia, postural instability, and rest tremor, with marked orthostatic hypotension. There was no evidence of dementia. Shy- Drager syndrome was diagnosed and Sinemet was started for the parkinsonian symptoms with an early positive response. Orthostatic hypotension continued to be a problem. She developed dysphagia for liquids more than solids. Given the advanced and refractory nature of her symptoms, hospice care was arranged for comfort, and she died in 2000.
