Multiple system atrophy with oculomotor abnormalities as a prominent manifestation: A case series.

RATIONALE: Multiple system atrophy (MSA) is a group of adult-onset sporadic neurodegenerative diseases, mainly classified as MSA-C and MSA-P types. Due to the diversity of clinical symptoms, diagnosis faces a significant challenge. In the present case, we report a patient with isolated vertigo as the first presentation and abnormalities of the oculomotor system as the characteristic manifestations.

CASE CONCERN: A 64-year-old male had dizziness for 1 year, aggravated for 4 months, with accompanying symptoms of unsteady walking. Physical examination revealed spontaneous nystagmus, abnormal ataxic movements, and a broad basal gait. Video nystagmography revealed saccade intrusions and macrosaccadic oscillations, and opsoclonus. Magnetic resonance imaging (MRI) was unremarkable early, and positron emission tomography-computed tomography (PET-CT) announced a reduction in the volume of the cerebellum and brainstem.

DIAGNOSIS: The diagnosis of the possibility of MSA type-C, peripheral neuropathy, hypertension, and lacunar cerebral infarction was performed.

CONCLUSION

Atypical early clinical presentation may lead to delays, and identifying the critical problem through the patient simple clinical status requires long-term clinical experience and various ancillary examination tools.