Misdiagnosis Analysis of Atypical Multiple System Atrophy and Literature Review

YE Jian; DONG Xiongfei

doi:10.3969/j.issn.1002-3429.2024.19.002

Abstract：Objective To investigate the clinical characteristics of multiple system atrophy(MSA)and to analyze the causes of misdiagnosis and preventive measures.Methods The clinical data of 2 patients with atypical MSA admitted from February 2022 to June 2023 were retrospectively analyzed.Results A female patient was admitted to hospital for urinary in-continence for 1 year and weakness in both lower extremities for 21 d.Cervical magnetic resonance imaging(MRI)showed cervical spinal stenosis and spinal cord compression,and urodynamic examination showed weakness of bladder contraction and hypesthesia of bladder,with progressive aggravation of symptoms to inability to walk,accompanied by hypesthesia in both low-er extremities,and the patient was diagnosed with myelitis.MSA was confirmed by electromyography,head MRI+magnetic resonance angiography+diffusion-weighted imaging and MRI of whole spinal cord combined with clinical symptoms.The mis-diagnosis lasted 1 year.The other female patient was admitted to hospital due to weakness of limbs and slow walking for 5 years.The above symptoms progressively worsened;there was left central facial palsy,dysarthria,tongue fibrillation,in-creased muscle tone,atrophy of large and small fish muscles,tendon reflex of extremities(+++),and pathological signs of lower limbs(+).Amyotrophic lateral sclerosis was initially considered.The diagnosis of MSA was confirmed by head MRI,susceptibility-weighted imaging and electromyography.The misdiagnosis lasted 10 d.After diagnosis,the symptoms of the two patients improved after receiving Dopa Serazine tablets and Pramexole Hydrochloride tablets.One patient was followed up for 1 year and confined to bed for a long period of time,while the other patient was followed up for 2 months without any discomfort.Conclusion MSA is a degenerative disease of the nervous system,with insidious onset,diverse initial symptoms,rapid pro-gression,and early misdiagnosis in early stage.In clinical practice,detailed history collection and physical examination,com-plete clinical evaluation,detailed autonomic nervous function examination and neuroimaging examination are the key to avoi-ding misdiagnosis.