Can We Improve Our Skills in Diagnosing Multiple System Atrophy?

A recent study showed that many patients diagnosed clinically with multiple system atrophy (MSA) have other conditions on autopsy. Therefore, researchers examined the clinical records of 203 patients with a diagnosis of MSA, comparing the presence, in those with and without postmortem confirmation of the diagnosis, of 12 supporting (“red-flag”) features: orofacial dystonia, disproportionate antecollis, camptocormia and/or Pisa syndrome, contractures of hands or feet, inspiratory sighs, severe dysphonia, severe dysarthria, snoring, cold hands and feet, pathological laughter and crying, jerky myoclonic postural/action tremor, and polyminimyoclonus. They also quantified seven disability milestones: frequent falls, use of urinary catheters, whe…