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Volume 09
Journal of Alzheimers Disease & Parkinsonism
ISSN: 2161-0460
Epilepsy 2019
Parkinsons Congress 2019
August 29-31, 2019
JOINT EVENT
conferenceseries
.com
August 29-31, 2019 Vienna, Austria
&
5
th
International Conference on
Epilepsy & Treatment
5
th
World Congress on
Parkinsons & Huntington Disease
Coexistence of MSA and PSP: A diagnostic challenge
Taha Assadnejad, Behrad Nassehi, Dursun Aygün
and
Mustafa Onur Yildiz
Ondokuz Mayıs University, Turkey
Introduction:
Multiple system atrophy (MSA) is a rare neurodegenerative disease characterized by progressive
autonomic failure and Parkinsonian/cerebellar features. Motor features are characterized by rigidity, slowness
of movement and tendency to fall in Parkinsonian subtype but ataxia, wide based gait and uncoordinated limb
movements predominate in cerebellar subtype. Progressive supranuclear palsy (PSP) is another neurodegenerative
disease which is characterized by Parkinsonism, vertical gaze palsy, backward falls and cognitive dysfunction.
Case:
Our case is of a 59 year old man who first presented with the chief complaints of dizziness and vertigo after
standing up five years ago. Postural instability, imbalance and backward falls began unexpectedly and gradually
progressed over three years. The patient cannot walk without assistance since 2017. He also suffers from erectile
dysfunction, urinary incontinence, speech impairment cognitive dysfunction and decreased verbal fluency. He
usually talks or shouts during sleep and cannot maintain sleep. Drugs such as Leva-dopa, Rasagiline and Amantadine
were prescribed for treatment but none of themwere effective. Neurological examination revealed vertical gaze palsy,
backward falls, wide based gait, postural instability, spastic dysarthria, bradykinesia, rigidity and mild cognitive
dysfunction. A MRI scan of the brain revealed “Hot cross bun sign” in Pons and “Hummingbird sign” in Midbrain
which are compatible with MSA and PSP respectively.
Conclusion:
As both MSA and PSP diseases are rare diseases, so we speculate that coexistence of these disorders
in a patient should be extremely rare, as only two cases of MSA and PSP coexistence have been reported. Although
postmortem autopsy is required for definitive diagnosis of MSA and PSP, the symptoms and signs of our case are
compatible with probable MSA and probable PSP according to their diagnostic criteria and we speculate that MSA
has progressed before PSP in this case.
Biography
Taha Assadnejad is pursuing his Medicine at Ondokuz Mayis University. He is interested in Neurologic and movement disorders and already he has started
research in these topics. He is the President of Neuroscience Society of Medical Faculty.
Taha Assadnejad et al., J Alzheimers Dis Parkinsonism 2019, Volume 09