Subarachnoid block for a case of multiple system atrophy

We report a case of multiple system atrophy in a 60-year-old man who presented twice for optical urethrotomy. Multiple system atrophy is associated with autonomic neuropathy, cerebellar ataxia, disordered control of respiration and paralysis of the abductors of the vocal cords and thus poses several problems for the anaesthetist. Subarachnoid block, which has not been described before in this group of patients, was administered twice and was well tolerated on both occasions.