The Study Of Cranial Magnetic Resonance And EAS-EMG And Ssr Characteristics In 32 Patients With Multiple System Atrophy

ObjectiveMultiple system atrophy（MSA）is a common clinical disease that invades the multigroup nervous system.The age of onset is more than 50 years old,and there is no obvious correlation between the cases,showing sporadic.The main clinical manifestations of the autonomic nervous system,cone system,cerebellum and other nervous system were violated by unknown causes.When MSA develops,it will involve different nervous systems and cause clinical manifestations.MSA is currently diagnosed with evidence of pathology.Compared with Parkinson’s disease（PD）and spinocerebellar ataxias（SCA）,these neurological degenerative diseases have clinical manifestations of MSA and they have considerable similarities.Clinical diagnosis and identification is relatively difficult.This article summarizes the history,clinical manifestations,general sequence of craniocerebral magnetic resonance,sphincter electromyography（EAS-EMG）,and sympathetic skin response（SSR）of 32 patients with multiple system atrophy（MSA）who have completed data from the outpatient and inpatient treatment at the Fifth Affiliated Hospital of Zhengzhou University from January 2015 to June 2017.The characteristics of electromyogram（EAS-EMG）and sympathetic skin response（SSR）were analyzed retrospectively to investigate the value of EAS-EMG and SSR in the early clinical diagnosis of MSA,thereby improving the clinicians ability of the disease diagnosis and recognition.MethodsA retrospective analysis of MSA outpatients and inpatients who had completed data from the Fifth Affiliated Hospital of Zhengzhou University from January 2015 to June 2017,32 cases were selected as the research object.The patients enrolled in the study were all in accordance with the revised Gilman diagnostic criteria in 2008.Exclude diseases such as skull base lesions by other means,there are no serious lumbar trauma and lumbosacral nerve root damage.None of the patients had history of pelvic floor surgery and vaginal delivery.All patients underwent the head of routine magnetic resonance imaging（MRI）and anal sphincter electromyography,sympathetic skin response test after who were admitted to hospital.Collecting MSA patients with general information,MRI,EAS-EMG,SSR examination results,treatment and prognosis.Combined with related domestic and international reports to discuss the clinical and neurophysiological characteristics of MSA patients.ResultsA total of 32 outpatients and inpatients with MSA were treated in the Fifth Affiliated Hospital of Zhengzhou University.The incidence of the disease was insidious and slowly progressing.The first symptoms are varied,and walking instability in this study was statistically significant between the two types（Comparison between MSA-P type and MSA-C type,P<0.05）.Among them,20cases of MSA-P type,the main clinical manifestations were Parkinson-like symptoms（Comparison between MSA-P type and MSA-C type,P<0.05）,12 cases of MSA-C type,The main clinical manifestation was cerebellar ataxia（Comparison between MSA-P type and MSA-C type,P<0.05）.All 32 patients completed conventional head MRI,and 28 patients had abnormal brain MRI.The putaminal slit sign on the T₂WI sequence was mainly seen on the MSA-P type（Comparison between MSA-P type and MSA-C type,P<0.05）,while the"cross sign"on the pons was mainly seen on the MSA-C type（Comparison between MSA-P type and MSA-C type,P<0.05）.The distance from the upper edge to the lower edge of the middle cerebellar peduncle was not statistically significant between the two types（Comparison between MSA-P type and MSA-C type,P>0.05）.Thirty patients with MSA completed the EAS-EMG examination.Among them,28 cases presented neurogenic damage.The main reason for this is that the patient has self-generating positions at rest.During light contraction,there is a delay in the mean duration of MUP,an increase in the number of polyphasic waves,and the presence of satellite potentials.Thirty-one patients with MSA completed SSR examination,and 27 cases presented autonomic nerve function damage,which was mainly attributed to the prolongation of the mean value of initial latency and the absence of waveform.EAS-EMG and SSR were not statistically significant between the two types（Comparison between MSA-P type and MSA-C type,P>0.05）.One patient died of hypoplastic pneumonia within 3 years,and the remaining patients were progressively worsened.ConclusionPatients with MSA often become occult and present with chronic progression.The age of onset is mostly after the age of 50.There is no correlation between morbidity and gender,the course of disease can vary in length.Due to the onset of the various systems involved in the sequence of different orders can cause a variety of clinical manifestations,combined with clinical features and conventional brain magnetic resonance examination results,and EAS-EMG,SSR and other auxiliary examination methods,can improve the diagnostic rate of MSA.In the early stage of the disease,when conventional magnetic resonance imaging of the skull fails to indicate the lesion,neurophysiological examination can provide supplementary diagnosis.When EAS-EMG examination is limited,SSR examination can provide supplementary diagnosis and reliable clinical reference.