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Multiple system atrophy — SCE Neurology MCQ

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EasyMovement DisordersMultiple system atrophySCE Neurology

A 42-year-old woman presented with parkinsonism with severe urinary retention and postural hypotension early in disease. On examination, there was cerebellar ataxia and pyramidal signs. Initial investigations showed: MRI showed putaminal rim and pontocerebellar atrophy. What is the most appropriate management?

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Correct answer: A — Multidisciplinary autonomic and movement-disorder supportive care

Multidisciplinary autonomic and movement-disorder supportive care is the best answer because the vignette describes Multiple system atrophy: early autonomic failure with parkinsonism/cerebellar signs suggests MSA. Multidisciplinary rehabilitation with goal-setting is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Anticoagulation after excluding contraindications and Optimise dopaminergic therapy and review motor fluctuations are less appropriate because they would require different localisation, timing or test findings; Start disease-specific immunotherapy under neurology supervision would fit a different syndrome. Clinical pearl: pure Parkinson's disease has autonomic symptoms later and lacks cerebellar signs.

Reference: NICE NG71; Movement Disorder Society consensus criteria