Wenning et al listed a number of "red flags" that should warn the clinician that s/he may be dealing with multiple system atrophy (MSA). The authors are from University Hospital in Innsbruck, Austria, and La Sapienza University in Rome.


Findings that may indicate that a patient has MSA:

(1) dysarthria

(2) jerky tremor

(3) axial dystonia (Pisa syndrome, camptocormia)

(4) orofacial dyskinesia and/or dystonia

(5) Parkinsonism with poor response to levodopa

(6) cerebellar ataxia

(7) early postural instability with falls (occurring within 3 years of disease onset)

(8) rapid progression despite dopaminergic therapy

(9) pyramidal signs

(10) anterior neck flexion (antecollis)

(11) severe dysautonomia

(12) cold feet and/or hands

(13) Raynaud's phenomenon

(14) inappropriate emotional outbursts

(15) abnormal breathing and/or sleep apnea related to symptom onset

(16) REM sleep disorder (muscle activity and/or vocalizations while dreaming)


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