Still diagnostic dilemma, with up to 25% misdiagnosis in UK neurologists of atypical PD (Parkinson's plus syndromes).
MSA-P = parkinson's type
MSA-C = cerebellar type
Orofacial dystonia with L-dopa is suspect for MSA.
Lymphocytic infiltrate in muscle causing neck weakness and trunk erector muscle can be seen in MSA.
- drug challenge - L-dopa, apomorphone
- olfactory testing - PSP
- EMG studies
- autonomic fcn
- genetic testing
- PET - 18-F-dopa, raclopride, FDG
- MRI - MRS, DWI
- transcranial U/S
Putaminal atrophy, putaminal slot sign, hypointensity seen in MSA. Atrophy of pons, etc. But limited sensitivity.
DWI - decreased restriction in putamen in MSA and PSP.
SPECT - D2 receptor imaging - reduced in MSA and PSP