Multiple system atrophy: Clinical, evolutive and histopathological characteristics of a series of cases

Background and objective: Multiple system atrophy is a rare and fatal neurodegenerative disorder, characterized by autonomic dysfunction in association with either parkinsonism or cerebellar signs. The pathologic hallmark is the presence of alpha-synuclein aggregates in oligodendrocytes, forming glial cytoplasmic inclusions. Clinically, it may be difficult to distinguish form other parkinsonisms or ataxias, particularly in the early stages of the disease. In this case series we aim to describe in detail the features of MSA patients. Material and methods: Unified MSA Rating Scale (UMSARS) score, structural and functional imaging and cardiovascular autonomic testing, are summarized since early stages of the disease. Results: UMSARS proved to be useful to perform a follow-up being longitudinal examination essential to stratify risk of poor outcome. Neuropathological diagnosis showed an overlap between parkinsonian and cerebellar subtypes, with some peculiarities that could help to distinguish from other subtypes. Conclusion: A better description of MSA features with standardized test confirmed by means of neuropathological studies could help to increase sensitivity. (c) 2021 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).

Automated summary

This study aims to describe the features of multiple system atrophy (MSA) patients in detail using the Unified MSA Rating Scale (UMSARS), structural and functional imaging, and cardiovascular autonomic testing. The results show that UMSARS is useful for follow-up and assessing the risk of poor outcome. The neuropathological diagnosis reveals overlapping features between parkinsonian and cerebellar subtypes of MSA, but also some peculiarities that help distinguish it from other subtypes. A better description of MSA features with standardized tests and neuropathological studies can increase sensitivity.