Objective: We couldn’t find an article showing that MSA and PSP appeared simultaneously in the same patient in the english literature. We wanted to present a three-year follow-up of a patient with a rare combination of MSA and PSP.

Background: Multiple system atrophy (MSA) and Progressive supranuclear palsy (PSP) are adult-onset and progressive neurodegenerative disorders. The early findings of MSA frequently are associated with autonomic dysfunction symptoms such as bladder dysfunction, erectile dysfunction in males and orthostatic hypotension. Postural instability and limitation of vertical gaze are the early findings in PSP. Early falls and vertical gaze palsy without dysautonomia may differentiate PSP from MSA. It has been reported that the hummingbird sign is a helpful diagnostic marker for the differential diagnosis of PSP.

Method: Case Report: This patient was referred for a neurological examination for the first time at the age of 56 years. He reported that the first symptoms occurred at the age of 55, when difficulties with speech and walking gradually developed. Sometimes, when he got up, he said he had a dizziness (moderate orthostatic hypotension). He also had mild urinary incontinence and severe erectile dysfunction. There was nothing special in her family history. Neurological examination (in the first application) revealed dysarthria, with occasional stuttering, slowing in vertical fast eye movements, bilateral pyramidal tract involve, and mild postural instability. Neurological examination of the patient after three years revealed severe dysarthria with hoarse, bulbar involve, hypomimia, symmetrical moderate bradykinesia with rigidity, bilateral pyramidal tract involve, gait and limb ataxia and severe postural instability. She also had severe orthostatic hypotension, severe urinary incontinence and modarate mental decline (slowed thinking and retrieval of information, poor organization reduced attention).

Results: Brainstem atrophy seen on brain magnetic resonance imaging (MRI) was more severe than in the first year in the fourth year of the disease course. Severe pons atrophy with the hot cross bun sign, midbrain atrophy with the hummingbird sign (concave upper surface) and cerebellar atrophy were seen on images.

Conclusion: Our patient showed that the simultaneous presence of two different neurodegenerative diseases in the same patient may adversely affect the disease course.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/three-year-follow-up-of-a-patient-with-a-rare-combination-of-taupathy-psp-and-synucleopathy-msa/