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MSA – Red Flag Features — SCE Neurology MCQ

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ModerateMovement DisordersMSA – Red Flag FeaturesSCE Neurology

A 65-year-old man presents with rapidly progressive symmetric parkinsonism with early falls, poor levodopa response, autonomic failure (urinary incontinence, severe OH), and inspiratory stridor. MRI brain shows hot cross bun sign and putaminal rim hyperintensity. What 'red flag' features most strongly suggest MSA rather than PD?

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Correct answer: B — Early severe autonomic failure, poor levodopa response, and inspiratory stridor

Red flags for MSA include: rapid progression, symmetric parkinsonism, poor or waning levodopa response, early severe autonomic failure (particularly urinary retention/incontinence and severe OH within 3 years of motor onset), inspiratory stridor/dysphonia, cerebellar ataxia, and characteristic MRI signs (putaminal rim hyperintensity, hot cross bun sign, cerebellar atrophy). A: Asymmetric rest tremor favours PD. B: Excellent levodopa response favours PD. D: Family history of tremor suggests essential tremor. E: Early cognitive impairment suggests DLB.

Reference: MDS MSA Diagnostic Criteria (2022); NICE NG71