Authors

  • Naira F. Aripova
    Researcher Tashkent Pediatric Medical Institute, Uzbekistan
  • Umida T. Omonova
    Researcher Tashkent Pediatric Medical Institute, Uzbekistan

DOI:

https://doi.org/10.37547/TAJMSPR/Volume06Issue07-05

Keywords:

Multiple system atrophy (MSA) ataxia parkinsonism

Abstract

Multiple system atrophy (MSA) is a steadily progressive neurodegenerative disease involving the pyramidal system, cerebellum, and autonomic nervous systemх[1]. MSA is an α-synucleinopathy with specific glioneuronal degeneration involving striatonigral, olivopontocerebellar, and autonomic nervous systems but also other parts of the central and peripheral nervous systems[3]. Clinical manifestations include hypotension, urinary retention, constipation, ataxia, parkinsonism, and postural instability. Multiple system atrophy affects both men and women equally, the first symptoms usually appear after age 53. The etiology of this pathology is unknown, but is associated with the accumulation of bodies containing alpha-synuclein in different parts of the brain[1]. There are two types of MSA. The first type occurs with a predominance of cerebellar dysfunctions: ataxia, postural instability. In the clinical setting of the second type of MSA, symptoms of parkinsonism predominate, such as muscle rigidity, bradykinesia, postural disturbances, non-resting tremor and dysarthria. Also, both types exhibit autonomic disorders. The prognosis for this pathology is unfavorable; after the first symptoms appear, life expectancy is 9-10 years.


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THE USA JOURNALS

THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN

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2689-1026)

VOLUME 06 ISSUE07

34

https://www.theamericanjournals.com/index.php/tajmspr

PUBLISHED DATE: - 27-07-2024

DOI: -

https://doi.org/10.37547/TAJMSPR/Volume06Issue07-05

PAGE NO.: - 34-37

CLINICAL CASE OF MULTISYSTEM ATROPHY
WITH PARKINSONISM


Naira F. Aripova

Researcher Tashkent Pediatric Medical Institute, Uzbekistan

Umida T. Omonova

Researcher Tashkent Pediatric Medical Institute, Uzbekistan

INTRODUCTION

At the moment, diagnosis and treatment are

limited. The diagnosis of multiple system atrophy

is made on the basis of clinical data from a
combination of signs of autonomic failure and

parkinsonism or cerebellar disorders, as well as
MRI data. There is no specific treatment for MSA;

only supportive therapy is provided [1]. The use of
a combination of antiparkinsonian drugs- levadopa

and carbidopa, may be ineffective or provide only
minor benefit. None of the available treatments

significantly slows the aggressive course of MSA[2].
There is a need to consider new methods to

maintain the quality of life of a patient with MSA at
an optimal level, prevent complications and

increase the life expectancy of patients.
Purpose of the study. To describe a clinical case of

Multiple System Atrophy with a predominance of
parkinsonian symptoms in old age.

RESEARCH OBJECTIVES

1. Analyze the theoretical concepts of Multiple

System Atrophy
2. Carry out a theoretical analysis of symptoms,

methods of diagnosis and treatment of patients

RESEARCH ARTICLE

Open Access

Abstract


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with MSA.
Materials and methods. Patient G., 62 years old,

was admitted with complaints of slow movements,
decreased strength in the arms and legs, a drop in

blood pressure, dizziness, instability when
walking, and intermittent tremor in the arms. The

above symptoms have been bothering him for 2
years. Life history: without any developmental

features.
During the examination, neurological examination:

the patient is conscious, oriented in time and place.
Blood pressure = 90/60 mm Hg. The sensitive area

is unchanged. Eye movement is complete. There
are no vertical seconds. The pupils are the same

D=S. Nystagmus is absent. There are no face zone
triggers. The face is symmetrical. There is no

smoothness of the nasolabial triangle. The tongue
occupies a central position, the uvula in the center.

There are no swallowing disorders. The pharyngeal
reflex is evoked. Hearing is not impaired. Muscle

tone is reduced. Tendon reflexes: evoked from the

arms and legs. Muscle strength is weakened. Static
coordination tests are unsatisfactory. Romberg test

is positive. Hyperkinetic syndrome - no. Scoliosis of

the spinal column - no. Movement in the limbs is
limited. There are no meningeal symptoms.
Bradykinesia, muscle rigidity, increasing after

functional tests. During the examination, Levadopa
125 mg was given. Functional tests were

performed 45 minutes after taking the tablet.
Based on complaints, medical history, and initial

examination, a preliminary diagnosis was made:
Parkinson's disease. Multiple system atrophy

(questionable). At the outpatient stage, an MRI of

the brain was prescribed.

RESULTS

The patient's condition did not improve while

taking Levadopa 125 mg, blood pressure = 80/40

mmHg, and when performing functional tests,

rigidity in the limbs did not decrease.


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Based on the results of an MRI of the brain (3

Tesla), the diagnosis was made:
Multiple system atrophy; there are signs of atrophy

in the pons, midbrain and cerebellum in T1 mode.
Diagnostic criteria for making this diagnosis are:

atrophic changes in the putamen, middle cerebellar
peduncles, pons and cerebellum. In addition, MSA

is characterized by the “cross” sign, often described

in

degenerative

spinocerebellar

ataxias,

hyperintensity of the dorsolateral edge of the
putamen in combination with hyperintensity of the

“vertical” signal from the suture [4]. Laboratory

markers of this disease are: an increase in the level

of total α

-synuclein and homocysteine, a decrease

in the level of coenzyme Q10 and uric acid [5].
Antihypotensive treatment was prescribed after

consultation with a cardiologist. Antiparkinsonian

drugs were not prescribed due to their
ineffectiveness.

CONCLUSION

This clinical example shows the features of the

course, difficulties of diagnosis and treatment of

Multiple system atrophy in an elderly patient.
Taking into account the high risk of complications

in such patients and the similarity of clinical and
instrumental signs, it was necessary to conduct a

differential diagnosis with the typical form of

Parkinson's disease, dementia with Lewy bodies,
true autonomic failure, autonomic neuropathies,

progressive supranuclear palsy, multiple cerebral
infarctions and drug-induced parkinsonism.
In the last few years, due to research and

technology development, a number of promising
imaging and laboratory markers have been

identified for the comprehensive diagnosis of MSA,

including at the initial stages of the
neurodegenerative process.

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https://www.msdmanuals.com/profession

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Jellinger KA. Multiple System Atrophy: An

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10.3233/JAD-170397. PMID: 28984582;


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THE USA JOURNALS

THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN

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2689-1026)

VOLUME 06 ISSUE07

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PMCID: PMC5870010.

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Beliveau V., Krismer F., Skalla E. et al.

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analysis. J. Neurol. 2021; 268: 2703

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2712.

DOI: 10.1007/s00415-020-09781-9

References

https://www.msdmanuals.com/professional/neurologic-disorders/autonomic-nervous-system/multiple-system-atrophy-msa?query=MSA

Poewe W, Stankovic I, Halliday G, Meissner WG, Wenning GK, Pellecchia MT, Seppi K, Palma JA, Kaufmann H. Multiple system atrophy. Nat Rev Dis Primers. 2022 Aug 25;8(1):56. doi: 10.1038/s41572-022-00382-6. PMID: 36008429.

Jellinger KA. Multiple System Atrophy: An Oligodendroglioneural Synucleinopathy1. J Alzheimers Dis. 2018;62(3):1141-1179. doi: 10.3233/JAD-170397. PMID: 28984582; PMCID: PMC5870010.

Kim M., Ahn J.H., Cho Y. et al. Differential value of brain magnetic resonance imaging in multiple system atrophy cerebellar phenotype and spinocerebellar ataxias. Sci. Rep. 2019; 9(1): 1–7. DOI: 10.1038/s41598-019-53980-y

Beliveau V., Krismer F., Skalla E. et al. Characterization and diagnostic potential of diffusion tractography in multiple system atrophy. Parkinsonism Relat. Disord. 2021; 85: 30–36.

Cong S., Xiang C., Wang H., Cong S. Diagnostic utility of fluid biomarkers in multiple system atrophy: a systematic review and meta-analysis. J. Neurol. 2021; 268: 2703–2712. DOI: 10.1007/s00415-020-09781-9