Parkinsonism and dysautonomia: Multiple system atrophy?

Albanese and colleagues present an intriguing 51 year old man with bilateral levodopa unresponsive parkinsonism and multidomain autonomic failure including severe postural hypotension (confirmed by cardiovascular autonomic testing), followed by urgency and urinary incontinence, impotence, occasional bowel incontinence suggesting a diagnosis of MSA-P at first sight [1]. MSA red flags including orofacial dystonia, anterocollis, camptocormia, contractures, minipolymyoclonus (jerky postural tremor), excessive new-onset snoring, inspiratory stridor, sleep apnea or REM sleep behavior disorder, cold hands or feet were remarkably absent throughout [2].
Source: Parkinsonism and Related Disorders - Category: Neurology Authors: Source Type: research