engleski

Differential Diagnostic Relevance of High Resolution Magnetic Resonance in Patients with Possible Multiple System Atrophy (MSA) : A Case Report

Multiple system atrophy (MSA) is sporadic, progressive neurodegenerative disorder characterized by combination of three possible group of dysfunctions: autonomic dysfunctions (MSA-A), Parkinsonism (MSA-P) and cerebellar dysfunctions (MSA-C). Parkinsonism is present in the majority of all patients (80%), and is associated with rapid progression of disease. Early in the course of the disease autonomic dysfunctions are present in approximately 40% of patients (later in almost all patients), while the domination of cerebellar symptoms is present in 20% of all patients. Brain magnetic resonance imaging (MRI) is the method with potential for objective quantification of main abnormalities that are critical in the differential diagnosis of MSA and related disorders. We present a case of 60-year old patient with history of progression (predominant cerebellar) symptoms, followed by the extrapyramidal symptoms and few mild symptoms of autonomic dysfunction, lasting six months. Patient was completely clinically investigated, including the complete neurological examination, psychological testing, cardiological evaluation (24 hours blood pressure monitoring, , 24 hours ECG heart rate variability), laboratory and radiological imaging (1.5T MRI, and additionally the 3T MRI). On initially performed 1.5T MRI, the most of neurodegenerative features of brain stem, cerebellum and basal ganglia (atrophy) were well illustrated, while relative typical MR features of MSA (“Hot-cross bun”) were detected only after MR imaging on higher resolution (3T) device. The level of quantification power of most neurodegenerative features was also much higher. In relative short period from the onset of the first symptoms, it is possible that the signs of autonomic dysfunction are not fully present and that the leading symptoms are cerebellar or/and extrapyramidal. This can be a differential diagnostic problem in establishment of the diagnosis of MSA according to existing algorithm based on clinical presentation. The “High-power” MRI, with special estimated sequences (T2 and FLAIR) in correlation with clinical picture, represents, in this (early) phase, a crucial diagnostic tool for establishing the definitive (clinical) diagnosis of MSA.

multiple system atrophy; high resolution magnetic resonance

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