Freelance Writing Jobs | Today's Articles | sign in

When an Older Man Faints—A Case

He Had Shy-Drager or Multi-system Atrophy, a Rare Cause

Apr 26, 2009 James Cooper

Doctors first think of heart irregularity or transient ischemic attacks as a cause of fainting. But another cause is suggested if certain characteristics are present.

Mr. K., 68 years old, found that when he stood up or walked a while, he felt light-headed or weak. On a walk, he often had to lean against a lamppost to “get my strength back.” He wasn’t short of breath, though, and had no heart or lung symptoms.

He had, however, become more “clumsy.” His gait was no longer smooth and rhythmic, and he stumbled at times. His family noticed his hands shook when he reached for something. They also noticed he had become “very emotional,” crying easily at minor situations, such as a sad TV show or book. Sometimes he cried in joy. But he always returned to normal in a few minutes.

His family didn’t know, but he also had erectile dysfunction and constipation.

Then he fainted on the street. The emergency team responded to the “man down” call and whisked him to the emergency room. Results of all the tests were within normal limits, and he went home the next day.

It took weeks until his health care team finally decided he had multi-system atrophy, and referred him to a specialty center.

What is Multi-System Atrophy?

It is a disorder of the brain. The cause is unknown. In some ways, it is similar to Parkinson’s Disease. It can involve nervous systems that control muscles and also systems that control blood pressure, and the cerebellum, which controls actions like walking.

While it “looks like” Parkinson’s Disease (PD) in some ways (muscle stiffness, tremor, affecting also speech and other functions), the pathology is different. In PD, affected brain cells contain distinct inclusions, Lewy Bodies. In multi-system atrophy (MSA), Lewy Bodies are not usually present. However, the parts of the brain affected by MSA do overlap with those affected by PD.

What is Shy-Drager?

This condition was described first, before the concept of multi-system atrophy was developed. Shy-Drager’s prominent sign is a fall in blood pressure when standing. The pressure drop can lead to feelings of weakness, even fainting. Brain changes in Shy-Drager disease were found to overlap with two other conditions, striatonigral degeneration and olivopontocerebellar atrophy, so now all three syndromes are considered part of MSA.

Possible Signs/Symptoms of MSA

Fall in blood pressure when standing (othrostatic hypotension)
Clumsy walking
Emotional lability (quick swings in and out of sadness)
Tremor on reaching for something (kinetic tremor)
Irregular non-functional often jerky dance-like movements (chorea)
Constipation
Double vision
Slightly slurred speech
Difficulty “getting started” in an activity requiring muscles
Headache, yawning, avoiding nicotine
Others

How is MSA/Shy Drager Treated?

While there is no cure yet, there are ways to lessen the burden of most of the symptoms. Academic centers that specialize in movement disorders can help. One is located at Vanderbilt University Medical Center, Nashville.

The copyright of the article When an Older Man Faints—A Case in General Medicine is owned by James Cooper. Permission to republish When an Older Man Faints—A Case in print or online must be granted by the author in writing.

MSA Is an Unusual Cause of Fainting