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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 8A0 Case 8 History
Case 8 History ---- This male patient was first seen in 2004 at the age of 45. His symptoms began gradually in 2002 at age 43, with increasing poor coordination of the lower extremities. Blood pressure was 157/87 sitting, 160/98 lying then 124/90 standing and 102/72 after 5 minutes. An MRI revealed borderline enlargement of the cerebellar fissures and posterior fossa cisterns suggestive of mild cerebellar atrophy. Treatment with midodrine, stockings and other medications was progressively disappointing. By 2006, the ataxia had become more severe in all four limbs and there was prominent nystagmus and dysarthria. There was sustained ankle clonus but the plantar reflexes were still flexor. Resting tremor was not helped significantly by Sinemet medication. Orthostatic hypotension was never adequately controlled with medications. By 2008 he had no functional use of either hand; the left failed first. Plantar reflexes became fully extensor in 2008 along with sustained ankle and wrist clonus. Feeding was maintained with a G tube; he had a retention catheter. The patient died at the age of 54 years. Clinical diagnosis was multiple system atrophy.
