Disclosures: Clarisse San Juan, MD: No financial relationships or conflicts of interest

Case Description: A 49 year old female presented with progressive weakness and frequent falls. She reports being recently diagnosed with Parkinson’s disease and started on dopaminergic medications, but the diagnosis was questionable because of the rapid progression of her symptoms. She also had symptoms of back pain and increased urinary frequency.

Setting: Hospital

Patient: A 49 year old female with Multiple System Atrophy (MSA) Assessment/

Results: Patient was on carbidopa-levodopa 50 mg-200 mg, but the patient’s symptoms still progressively worsened. CT head was essentially unremarkable, only showing a focal calcification in the right transverse sinus and focal fat in the anterior falx. Brain MRI results showed cerebellar, brainstem, and cerebral peduncle atrophy, suggestive of multiple system atrophy. Neurology diagnosed the patient with MSA-p which was why Parkinson’s medications were not helping with her symptoms.

Discussion: MSA is a rare disease affecting about 3.4-4.9 per 100,000 people in the United States. It has two predominant subtypes, MSA-predominant cerebellar ataxia (MSA-c) MSA-predominant Parkinsonism (MSA-p), which has higher incidence in the Western hemisphere. Not many cases of this disease have been described in literature, and because of the rarity of this disease, it may be missed as a diagnosis.

Conclusion: It is important to keep a broad differential in mind when dealing with patients with Parkinsonian features in order to prevent misdiagnosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-missed-multiple-system-atrophy-predominant-parkinsonism-a-case-report/