MULTIPLE SYSTEM ATROPHY: CASE OF ATYPICALPARKINSON WITH PARKINSON PREDOMINANT PRESENTATION AND PROGRESSIVE CEREBELLAR DEGENERATION WITH EXTRAPYRAMIDAL AND AUTONOMIC INVOLVEMENT

Abstract

ABSTRACT BACKGROUND Multiple System Atrophy is a rapidly progressive neurodegenerative disease. Symptoms tend to appear in 50s and advance rapidly over the course of 5-10 years with progressive loss of motor and autonomic function. Some of the common symptoms include frequent falls with or without tremors and b/l akinetic rigidity with involvement of the axial muscles. Postural tremor, severe stridor and cranio cervical dystonia may be seen. Alpha synnuclenopathies are generally characterized by REM behavioral disorders and severe dysautonomia years before the onset of the disease. Individuals with MSA typically do not have sustained improvement in their symptoms with levodopa. Currently, there are no treatments to delay the progressive neurodegeneration in MSA and there is no cure. However symptomatic treatment like drugs to improve orthostatic hypotension or anticholinergics for bladder control or compression stockings to overcome fainting can be adopted.[1] CASE DESCRIPTION A 60 year old male patient with known history of type 2 DM and HTN presented to JSS hospital with history of difficulty in speaking, walking and multiple episodes of falls, giddiness and involuntary movements of the hand and loss of bladder control progressing over a period of two years which was confirmed to be a case of Multiple System Atrophy (MSA-P) with progressive cerebellar degeneration, extrapyramidal and autonomic involvement. CONCLUSION The case report presents a progressive neurodegenerative condition which is a type of Atypical Parkinson with difficult diagnosis in the early stages due to its presenting complaints being very similar to Parkinson itself but progresses more rapidly