Multisystem atrophy under the guise of acute cerebrovascular accident

Multiple system atrophy (MSA) is a rare, sporadic, progressive neurodegenerative disorder belonging to the group of α-synucleinopathies and characterized by a combination of cerebellar and parkinsonian syndromes with manifestations of autonomic dysfunction. The morphological basis of MSA is the accumulation of pathological α-synuclein in oligodendrocytes with the formation of glial cytoplasmic inclusions. The polymorphism of clinical manifestations and the frequent mimicry of cerebrovascular pathology make the early diagnosis of MSA challenging. This article presents a clinical case of a patient admitted with suspected acute cerebrovascular event in the vertebrobasilar territory. Neuroimaging findings excluded acute vascular pathology. A detailed analysis of the medical history and neurological examination revealed a gradual progression of cerebellar symptoms (ataxia, intention tremor, dysarthria), parkinsonian features (bradykinesia, rigidity, resting tremor), and signs of autonomic dysfunction (urinary urgency). According to the contemporary diagnostic criteria proposed by the Movement Disorder Society (2022), the clinical presentation corresponds to clinically established MSA with a predominance of the cerebellar phenotype (MSA-C) and elements of parkinsonism. This case highlights the importance of a comprehensive clinical approach, careful evaluation of symptom progression, and consideration of autonomic dysfunction in the differential diagnosis of patients presenting with acute vestibular syndrome. Timely application of modern diagnostic criteria may improve the accuracy of early MSA diagnosis and optimize further patient management.

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