Case 33 - Man with gait impairment and urine incontinence

Summary

This chapter presents a clinical history of a patient who progressively complains of urinary incontinence requiring protective undergarments. He also presents postural hypotension. The patient was referred to a neurological department. After examination, the patient was diagnosed with Multiple System Atrophy (MSA) due to the co-existence of autonomic failure with orthostatic hypotension and Parkinsonism. The diagnosis of MSA was not incorrect, in that the patient presents the signs and patterns of this disease. In patients not responding to shunt surgery, cerebrovascular disease and Alzheimer's disease are the predominant disorders thought to mimick the normal pressure hydrocephalus (NPH) syndrome. This presumption is based on the fact that Alzheimer's disease and cerebrovascular disease are the most frequent causes of dementia, including cases improving after shunt operation. It has been hypothesized that NPH share common pathophysiology with Alzheimer's disease and/or cerebrovascular disease, which further confounds the clinical picture.