A 62-year-old man with Parkinson's disease presents with severe orthostatic hypotension, urinary incontinence, and impotence in addition to parkinsonism for 3 years. His tremor is bilateral and symmetric, and he shows poor response to levodopa. The most likely diagnosis is
- A Multiple system atrophy (MSA-P) ✓
- B Progressive supranuclear palsy
- C Parkinson's disease with autonomic involvement
- D Dementia with Lewy bodies
Correct answer: A. Multiple system atrophy (MSA-P)
Explanation
Multiple system atrophy (MSA-P) features prominent early autonomic dysfunction (orthostatic hypotension, urinary symptoms, erectile dysfunction), symmetric parkinsonism, poor levodopa response, and often cerebellar or pyramidal signs. In idiopathic PD, autonomic symptoms appear later and levodopa response is good. PSP features gaze palsy and early falls. DLB has cognitive fluctuations and hallucinations.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.