Sporadic multi-system atrophy with early onset and rapid fatal outcome (atypical O.P.C.A.?). Case report

The authors report the clinical, instrumental and histopathological data observed in a 27 year old man, who died 20 months after the onset of a rapidly progressive neurological syndrome referable to a multitopic brain damage. The clinical picture, which at its fully developed stage was represented by supranuclear ophthalmoplegia, cerebellar ataxia, akinetic-rigid parkinsonism with axial dystonia and dementia, appeared consistent with the diagnosis of P.S.P. The histological examination showed degenerative changes of varied degree in the cerebellum, the brain-stem and the basal ganglia, but the neurofibrillary tangles characteristic of P.S.P. were not found, either with electron-microscopy. The case presented considerable difficulties regarding its nosological classification. Nevertheless, the lack of neuropathological findings of storage disease as well as the particular location of the degenerative lesions have induced the authors to consider it as an atypical form of sporadic O.P.C.A. in the field of M.S.A.