A Life-threatening Complication of Multiple System Atrophy

Chest. 2021 Mar;159(3):e163-e166. doi: 10.1016/j.chest.2020.09.262.

Abstract

A 50-year-old woman was initially seen in 2016 for sleep disorders consultation, referred by Neurology because of progressive cerebellar ataxia syndrome with possible autonomic involvement and sleep-disordered breathing described as having stridorous sounds during her sleep. She had initially presented to Neurology because of issues with balance, and she had frequent falls at home. In 2016, her speech was clear, and she was able to ambulate steadily with a cane. She underwent a diagnostic polysomnogram that did not demonstrate clinically significant sleep apnea. However, the study demonstrated rapid eye movement (REM) sleep without atonia in 62% of REM epochs (normal, up to 27%) and a soft inspiratory stridor during non-REM and REM sleep. The patient was lost to follow-up until she presented to us for reevaluation 3 years later. In the interim, she had been diagnosed with multiple system atrophy-cerebellar type (MSA-C) at another health-care institution.

Publication types

  • Case Reports

MeSH terms

  • Autonomic Nervous System Diseases / diagnosis
  • Autonomic Nervous System Diseases / etiology
  • Autonomic Nervous System Diseases / physiopathology
  • Cerebellar Ataxia* / etiology
  • Cerebellar Ataxia* / physiopathology
  • Dependent Ambulation
  • Disease Progression
  • Fatal Outcome
  • Female
  • Humans
  • Middle Aged
  • Multiple System Atrophy* / diagnosis
  • Multiple System Atrophy* / physiopathology
  • Palliative Care / methods*
  • Polysomnography / methods
  • Positive-Pressure Respiration / methods
  • Postural Balance
  • Prognosis
  • Respiratory Sounds* / diagnosis
  • Respiratory Sounds* / etiology
  • Respiratory Sounds* / physiopathology
  • Sleep Apnea Syndromes* / diagnosis
  • Sleep Apnea Syndromes* / etiology
  • Sleep Apnea Syndromes* / therapy
  • Vocal Cord Dysfunction* / etiology
  • Vocal Cord Dysfunction* / physiopathology