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Case Reports in Medicine
Volume 2010, Article ID 351239, 4 pages
Case Report

Multiple-System Atrophy with Cerebellar Predominance Presenting as Respiratory Insufficiency and Vocal Cords Paralysis

1Department of Internal Medicine, Hospital São João, EPE, 4200-319 Porto, Portugal
2Department of Medicine, School of Medicine, Porto University, 4200-319 Porto, Portugal
3Department of Neurorradiology, Hospital São João, EPE, 4200-319 Porto, Portugal
4Department of Neurology, Hospital São João, EPE, 4200-319 Porto, Portugal

Received 1 June 2010; Revised 1 July 2010; Accepted 13 August 2010

Academic Editor: Gerald S. Supinski

Copyright © 2010 Ramon Andrade Bezerra de Mello et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. MSA (Multiple System Atrophy) may be associated either with Parkinsonism or with cerebellar ataxia (MSA-c subtype). It is considered a rare disease, but many patients are misdiagnosed as suffering from idiopathic Parkinson's disease. In this paper, we report a case of a patient admitted with respiratory failure and vocal cords paralysis due to MSA-c. Case Report. A 79-year-old Caucasian woman was admitted in March 2010 with dyspnea, asthenia, stridor, and respiratory failure needing noninvasive ventilation. She had orthostatic blood pressure decline, constipation, insomnia, daytime sleepiness, and snoring. The neurologic examination revealed cerebellar ataxia. A laryngoscopy revealed vocal cord paralysis in midline position and tracheostomy was performed. The Brain Magnetic Resonance Imaging revealed atrophy of middle cerebellar peduncles and pons with the “hot cross bun sign.” Conclusion. Although Multiple-system atrophy is a rare disease, unexplained respiratory failure, bilateral vocal cord paralysis, or stridor should lead to consider MSA as diagnosis.