Journal of Alzheimers Disease & Parkinsonism
Open Access

Abstract

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 them were 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.