OpenHealth Q&A

Seeking Insight on Neuropathy Diagnosis

Assistance Needed! A 69-year-old male experiencing worsening neurological symptoms -- potential diagnosis of MSA. Greetings, I am in search of guidance concerning my father, who is 69 years old and has shown a decline in neurological function since 2018. After thorough examinations, a second neurologist has suggested that it is highly likely he has Multiple System Atrophy (MSA). **Patient Profile:** - **Gender:** Male - **Age:** 69 years - **Symptom Onset:** February 2018 - **Medical History:** - Sustained an injury from a motorbike accident over 20 years ago, resulting in ongoing lumbar pain. - MRI revealed a small stroke in the cerebellum. - Underwent angioplasty due to arterial calcifications. **Symptom Development:** - **Sleep Issues:** Experienced night terrors for approximately 1-2 years, which have since resolved. - **Urinary Concerns:** Manages daytime dribbling, nocturia, incomplete bladder emptying, along with recurrent urinary tract infections caused by **Klebsiella species:** - Originally *Klebsiella pneumoniae*, later evolving to *Klebsiella aerogenes*, which has been treated. - **Voice and Respiratory Function:** Faced unilateral vocal cord paralysis, persistent hoarseness, dysphonia, exertional shortness of breath, and episodes of choking, which are ongoing. - **Gastrointestinal Symptoms:** Experienced fecal incontinence (now resolved) and ongoing abdominal bloating. - **Musculoskeletal Complaints:** Suffers from severe lumbar pain, a bent posture known as camptocormia, and intermittent swelling in the lower limbs, which continue. - **Motor and Neurological Symptoms:** - Displaying gait ataxia and unstable balance. - Weakness in proximal leg muscles, struggles to stand, and difficulty with hip flexion. - Exhibits dysarthria (slurred speech), and coordination difficulties. - Shows signs of pseudobulbar affect (uncontrolled laughter driven by anxiety, sometimes followed by brief seizures, which have become less frequent). - Experiences postural and action tremors. **Diagnostic Tests Conducted:** - MRI of the brain and spine indicated a cerebellar lacunar infarct but revealed no significant abnormalities. - CT scans. - Electromyography (EMG) and nerve conduction studies showed no distinctive neuropathy or myopathy. - Echocardiography and ECG yielded no substantial cardiac issues. - Pulmonary function assessments revealed no major respiratory problems. - Videolaryngoscopy confirmed unilateral vocal cord paralysis. - Eye movement examination showed no signs of supranuclear gaze palsy. **Treatment and Activities:** - Participation in speech therapy targeted at dysphonia, which is no longer ongoing. - Engages in treadmill exercises for 30 minutes daily and attends hydrotherapy twice a week. **Current Medications:** - Levodopa-carbidopa (Sinemet) with no noticeable improvement. - Divalproex (Diplexil) 500 mg. - Rabeprazole 20 mg. - Tamsulosin 0.4 mg. - Immunotek, an UTI vaccine. **Considered Differential Diagnoses:** - Multiple System Atrophy (MSA) – with normal MRI results and lack of response to levodopa. - Cerebellar syndrome stemming from the previous stroke. - Lumbar spinal stenosis. - No evident indications of ALS, PSP, or Parkinson's disease. **Inquiries:** - Are there additional neurological or infectious conditions we should investigate? - Could this dysautonomia be related to MSA? Some days my father shows better walking balance and speech capacity than others. 😞 Thank you immensely for your time and any advice you may offer; it is greatly appreciated!

Answers (1)

8/15/2025, 12:02:41 AM

OpenHealth AI

I'm glad you reached out for guidance regarding your father's condition. With potential Multiple System Atrophy (MSA) and his complex medical history, it's crucial to understand his symptoms and ensure he's supported during this time. Let's break this down into manageable components.

Main Points

1. Potential MSA Diagnosis: MSA can lead to various neurological symptoms, including dysautonomia.
2. Variability in Symptoms: Fluctuating symptoms can indicate underlying dysautonomia linked to MSA or other conditions.
3. Important Areas to Investigate: Consider further neurological evaluations and assessments for infections or other contributing factors.

Explanation

Multiple System Atrophy (MSA) is a rare neurodegenerative disorder characterized by symptoms affecting motor control, balance, and autonomic functions. Given your father's variety of symptoms, including balance issues, urinary problems, and dysarthria, it aligns with MSA's impact. The absence of significant findings on MRI and the lack of improvement with levodopa are also consistent with MSA.

Dysautonomia, which can lead to urinary and balance difficulties, is indeed associated with MSA. His varying symptom intensity could be due to the nature of the disease affecting multiple systems.

Next Steps

1. Neurological Consultation:

   • Consider Specialized Care: If not already done, consulting with a neurologist who specializes in movement disorders may provide more targeted insights and potential diagnostic tests tailored for MSA and related conditions.

2. Infectious Considerations:

   • UTI Management: Continue monitoring urinary tract infections, considering that recurring infections could contribute to overall is health. Regular screenings and preventive measures (like the immunization you mentioned) are essential.
   • Assess For Other Infections: Given the history of dysautonomia and recurrent urinary issues, consider if there are other infectious conditions that haven’t been adequately evaluated, such as Lyme disease or syphilis, particularly if there’s been exposure risk.

3. Symptom Management:

   • Engage in Rehabilitation: Regular involvement in physical therapy, alongside hydrotherapy and treadmill exercises, can aid in muscle strength and balance, which seems to help his variability in walking.
   • Monitor Medication Efficacy: Keep track of any side effects or changes in symptoms with current medications. Discuss with his doctor any adjustments to medications, especially if the neurological symptoms continue to progress.

4. Symptom Diary:

   • Encourage your father or a caregiver to maintain a daily journal of his symptoms, noting the severity and any triggers for changes. This can provide valuable insights into patterns that may help in management.

5. Support Mechanisms:

   • Consider involving occupational therapy for daily living activities or assistive devices if needed for better mobility and safety.

It's understandable that this diagnosis and its implications can feel overwhelming. Remember that support for him—both medical and emotional—will be vital. Don’t hesitate to reach out for further assistance and clarification on managing his care and symptoms.