This explanation is only intended to show the difficultness of establishing a MSA diagnosis. For additional questions, please refer to your treating physician.
Multiple system atrophy (MSA) is an adult-onset progressive neurodegenerative disorder that manifests clinically with autonomic failure, parkinsonism, and ataxia in any combination.
Currently, the second consensus criteria for an MSA diagnosis is used. However, it faces important problems such as poor diagnostic sensitivity and less than optimal specificity, especially at the early disease stages.
Below you can see a list of possible symptoms sometimes associated with a diagnosis of multiple system atrophy, which should be kept in mind by the physician. These symptoms could be a result of different disorders. Therefore, it takes an astute physician to draw out the correct diagnosis.
- Diabetes mellitus
- Uremia
- Liver disease
- Drug and toxin exposure (chemotherapy and radiotherapy)
- Boreliosis, syphilis, and HIV infection
- Amyloidosis
- Parkinsonism
- Perry syndrome
- Huntington’s disease
- Familial Parkinson’s Disease with the SNCA gene (FPD)
- Familial Parkinson’s Disease with the LRRK2 gene (FPD)
- Familial Parkinson’s Disease with the GBA gene (FPD)
- X-linked adrenoleukodystrophy (ABCD1 mutation)
- Sjogren’s syndrome
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Gluten ataxia
- Behçet’s disease
- Polypharmacy
- Dopaminergic drugs, especially levodopa (intestinal > oral)
- Antihypertensive drugs and diuretics
- Neuroleptic drugs
- Vasoactive drugs
- Hypovolemia (diarrhea, blood loss)
- Cardiopulmonary diseases (aortic stenosis, tachy- or bradyarrhythmia, ischemic cardiac disease, pulmonary embolism)
- Hypoglycemia
- Intoxication
- Epileptic or psychogenic nonepileptic seizure
- Benign prostatic hypertrophy (men)
- Pelvic floor relaxation/prolapse after multiple labors (women)
- Urinary infections
- Pelvic surgery
- Medication side effects
- Cardiovacular disease
- Smoking (men)
- Alcohol (men)
- Menopause (women)
- Thyroid disease
- Psychogenic
- Upper gastrointestinal tract masses
- Radiotherapy
- Achalasia and Esophageal spasms
- Upper gastrointestinal tract masses
- Radiotherapy
- Achalasia and Esophageal spasms
- Lower gastrointestinal tract masses
- Irritable bowel
- Inflammatory bowel disease
- Infectious diseases
- Antibiotics/food
- Thyroid and parathyroid disease
- Disorders of calcium metabolism
- Anal fissure
- Spinal cord injury
- Chronic laryngeal infection and laryngeal masses
- Chest masses causing extrinsic stenosis or affecting recurrent laryngeal nerve
- Iatrogenic lesions of recurrent laryngeal nerve during surgery
- Hypothyroidism
- Primary skin diseases
- Cataract and other primary eye disorders
- Peripheral artery disease
Resources for Further Information:
References
- Kim, Han-Joon et al. Multiple system atrophy-mimicking conditions: Diagnostic challenges. Parkinsonism & Related Disorders, Volume 22, S12 – S15
- Stankovic, I., et al., A critique of the second consensus criteria for multiple system atrophy. Mov Disord, 34: 975-984. doi:1002/mds.27701
Prepared By:
Dr. Oybek E. Turgunkhujaev (“Dr. Teo” ), Neurologist, Movement Disorders, Director, Complex Diagnostics, Semeynaya Clinic, Moscow, Russia