skip to main content

Multiple system atrophy — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardMovement DisordersMultiple system atrophySCE Neurology

A 58-year-old woman has rapidly progressive parkinsonism with urinary retention, postural hypotension and stridor. Examination shows limb ataxia and pyramidal signs as well as bradykinesia. MRI shows pontocerebellar atrophy with a cruciform pontine T2 signal. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Multiple system atrophy

Multiple system atrophy is the best answer. Autonomic failure, cerebellar signs, pyramidal features, stridor and hot-cross-bun MRI appearance support multiple system atrophy. Parkinson's disease lacks early severe autonomic/cerebellar disease; PSP is gaze/falls predominant; DLB presents with early dementia and hallucinations; Wilson's occurs younger with copper abnormalities. Clinical pearl: Early autonomic failure is a red flag against typical Parkinson's disease.

Reference: Movement Disorder Society MSA criteria; NICE NG71