Identification of multiple system atrophy mimicking Parkinson ’s disease or progressive supranuclear palsy

AbstractWe studied a subset of patients with autopsy-confirmed multiple system atrophy who presented a clinical picture that closely resembled either Parkinson ’s disease or progressive supranuclear palsy. These mimics are not captured by the current diagnostic criteria for multiple system atrophy. Among 218 autopsy-proven multiple system atrophy cases reviewed, 177 (81.2%) were clinically diagnosed and pathologically confirmed as multiple system atrophy (i.e. typical cases), while the remaining 41 (18.8%) had received an alternative clinical diagnosis, including Parkinson’s disease (i.e. Parkinson’s disease mimics;n  = 16) and progressive supranuclear palsy (i.e. progressive supranuclear palsy mimics;n  = 17). We also reviewed the clinical records of another 105 patients with pathologically confirmed Parkinson ’s disease or progressive supranuclear palsy, who had received a correct final clinical diagnosis (i.e. Parkinson’s disease,n  = 35; progressive supranuclear palsy-Richardson syndrome,n  = 35; and progressive supranuclear palsy-parkinsonism,n  = 35). We investigated 12 red flag features that would support a diagnosis of multiple system atrophy according to the current diagnostic criteria. Compared with typical multiple system atrophy, Parkinson ’s disease mimics more frequently had a good levodopa response and visual hallucinations. Vertical gaze palsy and apraxia of eyelid opening were more commonly observed in progressive supranuclear ...
Source: Brain - Category: Neurology Source Type: research