Multiple system atrophy with oculomotor abnormalities as a prominent manifestation: A case series

• Published in: Medicine (Baltimore) 2023-06, Vol.102 (25), p.e34008-e34008
• Main Authors: Wei, Yuanxiao, Chen, Ju, Lu, Cancan, Jiang, Yijing, Liu, Zhiqiang, Zhang, Wenzhao, Fang, Liqun
• Format: Article
• Language: English
• Subjects: Adult; Ataxia - complications; Cerebellum - pathology; Clinical Case Report; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multiple System Atrophy - diagnosis; Multiple System Atrophy - diagnostic imaging; Ocular Motility Disorders - diagnosis; Ocular Motility Disorders - etiology; Positron Emission Tomography Computed Tomography
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000034008

Multiple system atrophy (MSA) is a group of adult-onset sporadic neurodegenerative diseases, mainly classified as MSA-C and MSA-P types. Due to the diversity of clinical symptoms, diagnosis faces a significant challenge. In the present case, we report a patient with isolated vertigo as the first presentation and abnormalities of the oculomotor system as the characteristic manifestations. A 64-year-old male had dizziness for 1 year, aggravated for 4 months, with accompanying symptoms of unsteady walking. Physical examination revealed spontaneous nystagmus, abnormal ataxic movements, and a broad basal gait. Video nystagmography revealed saccade intrusions and macrosaccadic oscillations, and opsoclonus. Magnetic resonance imaging (MRI) was unremarkable early, and positron emission tomography-computed tomography (PET-CT) announced a reduction in the volume of the cerebellum and brainstem. The diagnosis of the possibility of MSA type-C, peripheral neuropathy, hypertension, and lacunar cerebral infarction was performed. Atypical early clinical presentation may lead to delays, and identifying the critical problem through the patient simple clinical status requires long-term clinical experience and various ancillary examination tools.