224 - Multisystem Atrophy in a 55-Year-Old African American Male with Symptomatic Progression

Case Diagnosis: A 55-year-old African American Male with multisystem atrophy predominant cerebellar ataxia (MSA-C)

 

Case Description: A 55-year-old African American male with a medical history of type 2 diabetes mellitus, hypertension, and glaucoma presented with a two-week history of right lower extremity weakness and slurred speech. The patient reported left lower extremity tremors over the past four days, which impaired his ability to walk. Notably, the patient experienced similar symptoms in 2022, which resolved at the time. Over the past two days, the patient developed episodes of lightheadedness and, for the first time, urinary incontinence. Physical examination revealed cerebellar deficits, including ataxia, saccadic eye movements, horizontal and vertical gaze instability. A non-contrast CT scan of the head demonstrated nonspecific hypoattenuation in the deep white matter, as well as global parenchymal atrophy. Given the patient's presentation and the progressive cerebellar atrophy, a diagnosis of multisystem atrophy was considered. There is no definitive treatment, but a comprehensive rehabilitation management plan was initiated, focusing on symptomatic and supportive care.

Discussions: This rare neurodegenerative disorder presents significant challenges in diagnosis and management. Although early imaging may be nonspecific, recurrent or worsening symptoms raise concern for progressive neurodegenerative processes. Ruling out other conditions is essential to clarify prognosis and guide supportive strategies. Additionally, managing comorbidities like diabetes and hypertension can influence outcomes. In the absence of definitive treatment, early recognition and comprehensive rehabilitation remain critical to preserving mobility, function, and quality of life.

Conclusions: Multisystem atrophy is a rare neurodegenerative disorder that requires early recognition through clinical evaluation and imaging, with multidisciplinary rehabilitation playing a key role in supporting patients through its progressive challenges.