MSA (Multiple System Atrophy)

Just wondering if he has been checked for any strokes. If this was a sudden change makes me curious. Not sure difference in parkinsons and msa. How do dr know the difference? Certain brain scans? My husband has parkinsons without tremors so i cant help think all these diseases share similarities.

My husband was diagnosed 12/4/25 with MSA-Type C based on a brain mri that showed moderate shrinkage in the cerebellum & brainstem. He hasn’t exhibited any of the violent behavior you describe, however, he has exhibited wild dreams occasionally which cause him to shout & move his arms wildly. Doctor told him to take 3mg melatonin & the dreams don’t occur very much currently. The doctor said the brainstem shrinkage affects emotions of joy & sadness; I don’t know if that would lead to your husband’s behavior though. The doctor hasn’t mentioned violence due to MSA & I haven’t found it in my research. I said a prayer for you & hope his violent outbursts stop.

Hello @lapaloma807 and welcome to Mayo Clinic Connect. I see that @jbug25 and @kaymirkes have responded to your post.

I'm also wondering which test(s) might have been performed to support the diagnosis of MSA. Was an MRI or PET scan done, or was this diagnosis based on the change in your husband's behavior? How are the other aspects of his Parkinson's symptoms? For example, has his mobility, balance, or speech changed? Has he been prescribed any medications for the agitation or violent outbursts?

Ive read about the difficulty in differentially making the diagnosis of Parkinsons vs MSA. To make it more challenging - there is MSA with Parkinsonian features and MSA with cerebellar features. I have not noted in the literature a propensity towards violent outbursts, but emotional liability can be a feature of all the neurodegenerative disorders. The active and at times violent dreams (REM sleep behavior disorder) is a well documented feature that has a 70 - 80% risk of development of alpha synuclein disorders (Parkinsons, MSA-P, MSA-C or Lewy-Body dementia). There are some excellent video lectures from respected neurologist available on You tube that can help sort things out, but it still remains a challenge to diagnose any of them in the early stages. I'm diagnosed with Primary Autonomic Nervous System Failure and early Parkinsons by my neurologist. I'm trying to keep up to date as much as I can. So far I'm Rx"d Midodrine to support my BP due to orthostatic hypotension and Klonopin for REM sleep behavior disorder - both have really helped. What symptoms or scan results prompted your husband's dx of MSA-C?

Jim’s first sign was his gait changed to smaller slower steps, then like baby steps & he felt a little unbalanced. That prompted him to see a neurologist (not movement disorder specialist). The first doctor told him to do PT which improved him from 30 to 70% but he failed to continue the exercises after PT appointments ended, so his gait got worse. Next symptom was speech difficulty; somewhat garbled & hard to understand. And then he started the REM sleep disorder. And his handwriting became terrible; fine motor skills declined. Two years later that doctor suggested PD so he tried carb-levo which was ineffective. I contacted the National Parkinson’s Foundation & found wonderful help from a woman who was so gracious & knowledgeable. She said we needed to see a movement disorder specialist & she sent a list of them in our area of Texas. Next step was seeing a specialist at UT Southwestern Medical Center in Dallas in their neurology department. He suggested Normal Pressure Hydrocephalus so a brain mri was done. However, that was clearly ruled out & he was given the diagnosis of MSA-Type C because the mri showed moderate atrophy in the cerebellum & brainstem. So the next step is getting an appointment with their MSA Clinic & the hope of qualifying for clinical trials. The diagnosis was coupled with a physical exam done in the office (walking, turning, eye movement, etc). An MSA diagnosis is their best educated guess because it can only be confirmed through brain autopsy. When Jim asked the doctor what can be done, he answered, “Exercise, PT, OT, speech therapy. Exercise is paramount.”

I appreciate your hug!

@kaymirkes
The shorter walking stride, small handwriting, slight unsteadiness and slower movements are all familiar to me too. One key feature of MSA is early presentation of urinary problems (difficulty voiding , urgency and incontinence). Exercise helps with Parkinsons and Levodopa helps with motor problems, but not so much with MSA. MSA progresses faster than Parkinsons and can lead to disability within 6 years. No current tx for MSA outside what may be available thru a clinical trial. You are not alone - sending love and a hug your way. B