Example differential diagnosis – multiple system atrophy (MSA)

Multiple system atrophy (MSA) is an adult-onset, fatal disease, with a constellation of autonomic, cerebellar, and pyramidal symptoms, including parkinsonism.^1,2 Pathologically, MSA is characterised by α-synuclein-positive inclusion bodies that form in glial cells of affected brain regions, including the striatonigral and/or olivopontocerebellar systems.^1,3

References:
1.Niccolini F, Politis M. A systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism. Eur J Nucl Med Mol Imaging 2016; 43 (12): 2244–2254.

2.Wenning GK, Ben Shlomo Y, Magalhães M, et al. Clinical features and natural history of multiple system atrophy. An analysis of 100 cases. Brain 1994; 117 (Pt 4): 835–845.

3.Wakabayashi K, Takahashi H. Cellular pathology in multiple system atrophy. Neuropathology 2006; 26 (4): 338–345.