Rare presentation of hallucinations in cerebellar multisystem atrophy

Psychotic symptoms are seen in patients with medical disorders. Multisystem atrophy (MSA) is a neurodegenerative disorder which is rapidly progressive. It can occur in two forms; one with parkinsonian features (MSA-P) and other with cerebellar ataxia (MSA-C). The prevalence of this disorder is about 2-5 per 1,00,000 individuals. Neuropsychiatric symptoms like depression, apathy and anxiety have been reported frequently in these patients but there are isolated reports describing hallucinations in patients with MSA. It is mostly seen in patients with parkinsonian type of MSA rather than cerebellar type of MSA. Here we report a rare case of psychotic disorder in a patient with cerebellar type of multi-system atrophy.

DIAGNOSTIC DIFFICULTIES IN MOTOR DISORDERS

The article is devoted to the diagnosis of motor disorders in extrapyramidal pathology, namely, the course of multisystem atrophy, which is a steadily progressing neurodegenerative disease, accompanied by damage to the pyramidal system, cerebellum and autonomic nervous system and is associated with degeneration of nerve cells in certain parts of the brain. Emphasis is placed on the diagnosis of conditions in the clinical picture of which tremor dominates, which occurs as a result of damage to the structures of the nervous system related to the regulation of muscle tone and unreasonable control of movements (cerebellum, basal ganglia). Tremor is hyperkinesis, which is manifested by involuntary oscillatory rhythmic movements of a part (limbs, head) or the whole body as a result of a constant repetition of muscle contraction and relaxation. Making diagnosis of the diseases underlying this condition is often a challenging task that requires a proper diagnostic approach. There has been presented clinical and paraclinical methods for the diagnosis of trembling hyperkinesis, described advantages of electromyography (tremorography, ultrasonography) in the diagnosis of extrapyramidal diseases. The article includes a case report of a patient with hyperkinetic syndromes at multisystem atrophy, who was examined and treated at the Centre for Patients with Parkinson's disease and other neurodegenerative diseases at the Department of Nervous Diseases with Neurosurgery and Medical Genetics, Ukrainian Medical Dental Academy, Neurological Department of the Poltava Regional Clinical Hospital, details the stages in making final diagnosis. The article sums up on the efficiency of neurophysiological methods in early diagnosis and in disease progression.