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What Causes Multisystem Atrophy?
Question: Yes, please. I wonder if I have MSA.
Brief Answer:
Uncommon in women
Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am an adult neurologist from XXXXXXX OH. My family used to live in XXXXXXX as I see you're from XXXXXXX
MSA or multisystem atrophy is one of the forms of Parkinson's Plus diseases which primarily feature autonomic dysfunction on a backdrop of either parkinsonian features such as slow movements, slow speech, and slowed activities in general or cerebellar dysfunction such as falls and in-coordination without too much slowness at the outset. Eventually, as the disease progresses there is a reduction in body/limb strength and swallowing difficulties reach critical levels.
The presentation of MSA is usually seen in men (2:1, sometimes quoted as even higher) with the start of symptoms with symptoms predominating of either a parkinsonian or cerebellar type or possibly severe orthostatic hypotension (OH).
So while I agree that some of your symptoms such as neurogenic bladder, cold hands/feet, imbalance, and OH can be considered red flags for MSA they could also be part of other things such as Pure Autonomic Failure (PAF). There could be other explanations for your individual symptoms as well.
What is needed is a good thorough neurological evaluation by someone who is sensitive to Parkinson's Plus syndromes and who is not afraid of possibly following someone for several years before being able to make a firm diagnosis.
There are imaging studies such as MRI, PET, and Iodine Scintigraphy which can help distinguish MSA from other forms of movement disorders. Also, autonomic function testing should be considered in any patient suspected as having MSA.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 40 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Uncommon in women
Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am an adult neurologist from XXXXXXX OH. My family used to live in XXXXXXX as I see you're from XXXXXXX
MSA or multisystem atrophy is one of the forms of Parkinson's Plus diseases which primarily feature autonomic dysfunction on a backdrop of either parkinsonian features such as slow movements, slow speech, and slowed activities in general or cerebellar dysfunction such as falls and in-coordination without too much slowness at the outset. Eventually, as the disease progresses there is a reduction in body/limb strength and swallowing difficulties reach critical levels.
The presentation of MSA is usually seen in men (2:1, sometimes quoted as even higher) with the start of symptoms with symptoms predominating of either a parkinsonian or cerebellar type or possibly severe orthostatic hypotension (OH).
So while I agree that some of your symptoms such as neurogenic bladder, cold hands/feet, imbalance, and OH can be considered red flags for MSA they could also be part of other things such as Pure Autonomic Failure (PAF). There could be other explanations for your individual symptoms as well.
What is needed is a good thorough neurological evaluation by someone who is sensitive to Parkinson's Plus syndromes and who is not afraid of possibly following someone for several years before being able to make a firm diagnosis.
There are imaging studies such as MRI, PET, and Iodine Scintigraphy which can help distinguish MSA from other forms of movement disorders. Also, autonomic function testing should be considered in any patient suspected as having MSA.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 40 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
My neurologist insist that I don't have MSA because recent CT scans do not change brain changes or abnormalitites. I'd like your opinion, please. He does concede that I have some "red flag" symptoms. I am getting worse......Thank you for your time, speed of response, and ease of understanding.
Brief Answer:
Neurologist who can examine you should have DIAGNOSTIC ADVANTAGE
Detailed Answer:
Good morning. Thank you for the return message.
I believe it would be extremely difficult for ME to counter (or even confirm) any arguments of whether or not a patient had a condition such as MSA if the other doctor had the advantage over myself in terms of being able to physically examine and see you....don't you agree? Even though people can sometimes match symptoms of what they are feeling to a list which turns out to be consistent with a particular disease process- this does not mean that the person has that disease. Physical Examination and other factors have to also be weighed.
In this case, the ONLY things I am able to do is tell you what I know to be true in any general patient with MSA in terms of their symptoms and progression. You certainly do have some of the "red flag" symptoms of an MSA patient. On the other hand, if we were to take your symptoms as a collective group and match them against other potential disease processes we would be able to likely find at least a half dozen other things that could also be the case. How did you come to believe you may have MSA? Was it through your reading on the subject or did someone else suggest that possibility? I see from your list of TRIED medications that you've been through at least other possibilities such as Myasthenia Gravis, Autonomic Failure or Deficiency,
Medical students do this sort of thing all the time when studying their books to become doctors. Some people go through their entire academic career thinking they've had nearly every disease they've read about....and then, some! LOL....Luckily, they've never had one of those diseases. What I'm getting at is the fact that there is really nothing in the world that substitutes a medical diagnosis from a computer chair and screen such as what I have to work with with an actual opportunity to see, touch, and hear the patient in front...which is what YOUR NEUROLOGIST has to work with.....as far as basing the conclusion of MSA or not on the lack of changes on a CT scan.....I may slightly disagree with that approach and suggest that the imaging study of choice be an MRI since it is so much more sensitive than CT to see actual structural detail of the brain.
But I understand what he's saying all the same. I may be that in his opinion the imaging study you've got isn't even being weighed as an important factor simply because in his medical judgement and after a good history and examination of your problems he feels that you simply don't have MSA. Again, I'm not in any type of position to counter that feeling unless you were to physically PRESENT YOURSELF to me for examination. (Wanna come to XXXXXXX Ohio? We are actually a very beautiful town these days....a lot of hustle and bustle as the city prepares to host the 2016 Republican Convention! LOL).
And so in closing this response, I would suggest that an MRI of the brain be obtained since that is a much more sensitive test than CT if your neurologist will agree to it...but again, their discretion may override that suggestion only because I'm not sure whether the neurologist feels that an imaging study is even necessary if he has other information at his disposal that I'm not privy to....does that make sense?
Once again, though the symptoms you've listed can be found in patients with MSA of some form, I believe my other response to you outlined for you the separation of MSA into 2 major categories. One is where there are Parkinsonisms involved....sometimes to the point where even neurologists will mistake the disease process for Parkinson's disease...only to find out later that patients are either briefly or erratically responsive to dopamine drugs such as Sinemet, Mirapex, Requip, etc. That's one of the first clues that the person DOESN'T HAVE Parkinson's. The second potential category to consider would be an MSA patient whose form is mainly based upon CEREBELLAR DEGENERATION. This would probably be the best reason to get the MRI instead of the CT scan since the cerebellar atrophy and brainstem atrophy that might be seen in MSA of the CEREBELLAR TYPE is best observed on MRI and not so well on CT.
And so your symptoms to me....don't sound like they fit well into either of those categories. But what they do seem to speak to would be some type of affectation of your autonomic nervous system so that a diagnosis of Autonomic failure...maybe even the condition of Pure Autonomic Failure (PAF) could be placed into the differential to work on. For that diagnosis you would require Autonomic Function Testing which would be done in a special lab with a number of tests. Has that been done yet or would you have access to such a lab? There aren't too many in the country that are fully equipped for complete testing.
Luckily I do know a doctor who runs a fully equipped lab in XXXXXXX VA which you may be geographically close to if another lab weren't closer. Again, perhaps your neurologist has already considered this possibility and worked you up so I'm not sure...
Bottom line is that I still have a hard time pegging you with any certainty into a diagnosis of MSA based upon everything I've said and in conjunction with the fact that a local neurologist who has examined you and seen at least a CT of your head doesn't believe that's the case. However, as I just indicated there is a way of doing a complete assessment of your autonomic nervous system with Dr. XXXXXXX Chemali who heads the Autonomic Function Division in XXXXXXX VA.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 40 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Neurologist who can examine you should have DIAGNOSTIC ADVANTAGE
Detailed Answer:
Good morning. Thank you for the return message.
I believe it would be extremely difficult for ME to counter (or even confirm) any arguments of whether or not a patient had a condition such as MSA if the other doctor had the advantage over myself in terms of being able to physically examine and see you....don't you agree? Even though people can sometimes match symptoms of what they are feeling to a list which turns out to be consistent with a particular disease process- this does not mean that the person has that disease. Physical Examination and other factors have to also be weighed.
In this case, the ONLY things I am able to do is tell you what I know to be true in any general patient with MSA in terms of their symptoms and progression. You certainly do have some of the "red flag" symptoms of an MSA patient. On the other hand, if we were to take your symptoms as a collective group and match them against other potential disease processes we would be able to likely find at least a half dozen other things that could also be the case. How did you come to believe you may have MSA? Was it through your reading on the subject or did someone else suggest that possibility? I see from your list of TRIED medications that you've been through at least other possibilities such as Myasthenia Gravis, Autonomic Failure or Deficiency,
Medical students do this sort of thing all the time when studying their books to become doctors. Some people go through their entire academic career thinking they've had nearly every disease they've read about....and then, some! LOL....Luckily, they've never had one of those diseases. What I'm getting at is the fact that there is really nothing in the world that substitutes a medical diagnosis from a computer chair and screen such as what I have to work with with an actual opportunity to see, touch, and hear the patient in front...which is what YOUR NEUROLOGIST has to work with.....as far as basing the conclusion of MSA or not on the lack of changes on a CT scan.....I may slightly disagree with that approach and suggest that the imaging study of choice be an MRI since it is so much more sensitive than CT to see actual structural detail of the brain.
But I understand what he's saying all the same. I may be that in his opinion the imaging study you've got isn't even being weighed as an important factor simply because in his medical judgement and after a good history and examination of your problems he feels that you simply don't have MSA. Again, I'm not in any type of position to counter that feeling unless you were to physically PRESENT YOURSELF to me for examination. (Wanna come to XXXXXXX Ohio? We are actually a very beautiful town these days....a lot of hustle and bustle as the city prepares to host the 2016 Republican Convention! LOL).
And so in closing this response, I would suggest that an MRI of the brain be obtained since that is a much more sensitive test than CT if your neurologist will agree to it...but again, their discretion may override that suggestion only because I'm not sure whether the neurologist feels that an imaging study is even necessary if he has other information at his disposal that I'm not privy to....does that make sense?
Once again, though the symptoms you've listed can be found in patients with MSA of some form, I believe my other response to you outlined for you the separation of MSA into 2 major categories. One is where there are Parkinsonisms involved....sometimes to the point where even neurologists will mistake the disease process for Parkinson's disease...only to find out later that patients are either briefly or erratically responsive to dopamine drugs such as Sinemet, Mirapex, Requip, etc. That's one of the first clues that the person DOESN'T HAVE Parkinson's. The second potential category to consider would be an MSA patient whose form is mainly based upon CEREBELLAR DEGENERATION. This would probably be the best reason to get the MRI instead of the CT scan since the cerebellar atrophy and brainstem atrophy that might be seen in MSA of the CEREBELLAR TYPE is best observed on MRI and not so well on CT.
And so your symptoms to me....don't sound like they fit well into either of those categories. But what they do seem to speak to would be some type of affectation of your autonomic nervous system so that a diagnosis of Autonomic failure...maybe even the condition of Pure Autonomic Failure (PAF) could be placed into the differential to work on. For that diagnosis you would require Autonomic Function Testing which would be done in a special lab with a number of tests. Has that been done yet or would you have access to such a lab? There aren't too many in the country that are fully equipped for complete testing.
Luckily I do know a doctor who runs a fully equipped lab in XXXXXXX VA which you may be geographically close to if another lab weren't closer. Again, perhaps your neurologist has already considered this possibility and worked you up so I'm not sure...
Bottom line is that I still have a hard time pegging you with any certainty into a diagnosis of MSA based upon everything I've said and in conjunction with the fact that a local neurologist who has examined you and seen at least a CT of your head doesn't believe that's the case. However, as I just indicated there is a way of doing a complete assessment of your autonomic nervous system with Dr. XXXXXXX Chemali who heads the Autonomic Function Division in XXXXXXX VA.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 40 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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