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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 6A0 Case 6 History
Case 6 History ---- This 74yo female was first seen in the MDC at age 70 years. At age 60, she developed left hand tremor with action and at rest. At age 61, she developed stiffness in both legs, felt imbalanced and had frequent falls, one resulting in bilateral leg fractures. By age 62, she became slower in all ADLs and walked with a walker. All of these symptoms progressed over the next 5 years and she entered residential care at age 67. By that point, steps were small, she had difficulty arising from a chair, difficulty rolling in bed, developed small handwriting, became incontinent of urine and had less animated facial expression. She developed some freezing of gait. By age 70, she had swallowing problems with liquids. Thinking was relatively preserved. Exam at age 70, revealed left hand resting tremor, mildly asymmetric bradykinesia (worse on left), symmetric rigidity (but worse at neck) and severe postural instability. Over the next year, levodopa provided modest benefit with reduced tremor but other manifestations were only minimally, if any, improved. She had no complaints of orthostasis. By age 72, she had occasional visual hallucinations which may have only been associated with an anticholinergic drug given for bladder dysfunction. She developed increasing difficulty with oral intake, frequent UTIs, bowel obstruction, contractures of the ankles, progressive heart failure with cor pulmonale and a history of pulmonary emboli and MIs. She died of heart failure at 74 years of age.
