MULTIPLE SYSTEM ATROPHY: 5 CASES

Multiple system atrophy (MSA) is a rare, sporadic and progressive neurodegenerative syndrome characterized by various combinations of parkinsonian, cerebellar, autonomic or pyramidal signs with an onset in adulthood. It has been classified as MSA-P or MSA-C depending on the type of dominant symptoms, either parkinsonism or cerebellar ataxia, respectively. In this report, we have presented five patients diagnosed as MSA based on the clinical signs varying from parkinsonian symptoms to cerebellar ataxia. While dysarthria, hyperreflexia and urinary dysautonomia were the common findings in all of these patients, other clinical and radiological signs supporting MSA were observed in different combinations. Patients under levodopa or dopamine agonist therapy due to parkinsonian symptoms responded poorly and a progressive clinical course was observed in all five patients. It is important to consider this rare syndrome in the differential diagnosis of the patients displaying rapidly progressive parkinsonism and/or cerebellar symptoms accompanied by autonomic signs and responding poorly to Parkinson disease therapy.