Objective: The aim of the this study to review the diagnostic challenges of MSA and to evaluate the patients with different clinic types of MSA- P and MSA-C.

Background: Multiple system atrophy (MSA) is an adult-onset sporadic neurodegenerative disorder characterized by any combination of parkinsonism, cerebellar ataxia, and autonomicfailure. Patients with MSA can present with a wider range of clinical features and have more variable disease courses. Clinical features for a diagnosis of MSA consist of autonomic failure in combination with motor symptoms. Motor symptoms include poorly levodopa-responsive parkinsonism (MSA-P)  or cerebellar ataxia (MSA-C).

Methods: Ten patients with possible MSA included the study. All patients evaluated according to second consensus statement on the diagnosis of multiple system atrophy (Gilman S-2008). The patients were categorized for different types of MSA-P and MSA-C by the clinician who experienced on the movement disorders.

Results: Six of the patients were female. The mean age of patients were 65.6. Seven patients were diagnosed idiopatic Parkinson’s disease and three patients were diagnosed ataxia disorder by the neurologist in the prior time. All patients had hot cross bun’ sign on the MRI and orthostatic hypotension. Five patients had dominantly cerebellar features  and other patients had dominantly parkinsonism features with initial symptoms. Also, eight patients had rem sleep behavior disorder.

Conclusions: This study shows that MSA is frequently taken wrong diagnosis by neurologist who  first examined with initial years.

References: 1- Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Dürr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M. Second consensus statement on the diagnosis of multiple system atrophy Neurology. 2008 Aug 26;71(9):670-6. doi: 10.1212/01.wnl.0000324625.00404.15.

2- Fanciulli A, Wenning GK, multiple system atrophy N Engl J Med 2015; 372:249-263

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-diagnostic-challenges-of-patients-with-possible-multiple-system-atrophy/