neurologic disorders
Multiple System Atrophy (MSA)
Symptoms and Signs of Multiple System Atrophy
Initial symptoms of multiple system atrophy vary but include a combination of Parkinsonism unresponsive tolevodopa Cerebellar abnormalities Symptoms due to autonomic insufficiency Symptoms and Signs predominate in striatonigral degeneration. They include rigidity, bradykinesia, postural instability, and jerky postural tremor. High-pitched, quavering dysarthria is common. In contrast to Parkinson disease, multiple system atrophy usually does not usually cause resting tremor and dyskinesia, and symptoms respond poorly and transiently tolevodopa. Cerebellar abnormalities predominate in olivopontocerebellar atrophy. They include ataxia, dysmetria, dysdiadochokinesia (difficulty performing rapidly alternating movements), poor coordination, and abnormal eye movements. Typically, autonomic insufficiency causes Orthostatic Hypotension (symptomatic fall in blood pressure (BP) when a person stands, often with syncope), Other autonomic symptoms, which may occur early or late, include decreased sweating, difficulty breathing and swallowing, Fecal Incontinence , and decreased tearing and salivation. Rapid eye movement (REM) sleep behavior disorder (eg, speech or skeletal muscle movement during REM sleep), respiratory stridor, and sleep apnea are common. Patients are often unaware of REM sleep behavior disorder. Patients may have nocturnal polyuria; contributing factors may include a circadian decrease inargininevasopressinand treatments used to increase blood volume. 