Peripheral neuropathy as the presenting feature of multiple system atrophy

The authors report a case of multiple system atrophy (MSA) with an onset as a peripheral nerve involvement. Their patient, a 55-year-old man, had a 3- year history of distal weakness and atrophy in upper limbs with dysesthesia in the feet. Other identifiable causes of peripheral neuropathy were ruled out. The authors postulate that peripheral nervous system impairment can a nticipate the typical appearance of MSA, and they suggest that, in peripher al neuropathies with autonomic system dysfunction, after excluding main cau ses of autonomic neuropathy, MSA may need to be suspected.