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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 9A0 Case 9 History
Case 9 History ---- About 1987, when she was 59 years old, this female noticed incoordination of gait. After several years she had dysarthria and ataxia of all four limbs. Gait was wide based and unsteady. She was intellectually intact with severe dysarthria. Blood pressure was 174/108. There were two or three beats of lateral gaze nystagmus. She developed recurrent urinary incontinence. She could swallow satisfactorily, but slowly. Acute inspiratory distress developed and an otolaryngologist observed paretic vocal cords resulting in a tracheostomy. Urinary incontinence required retention catheterization. In September 1992 she first complained of faintness when standing; standing blood pressure was recorded at 70/50. Treatment with fludrocortisone was helpful, but nevertheless she had several syncopal episodes while sitting over the next two years. During one spell while sitting on the toilet she was observed to be cyanotic, unconscious, and had jerking of the left limbs. These attacks were aborted by having her lie flat. In 1994 her lateral gaze nystagmus had become very prominent and there was diplopia on far lateral gaze. The patient remained intellectually intact and after extended discussion with her children, she elected the option of a gastrostomy in March 1995. Later in 1995 he had recurrent respiratory infections and finally expired in early 1996.
