From: An update on the cerebellar subtype of multiple system atrophy
Red flag | Definition |
---|---|
Early instability with recurrent falls | within 3 years of disease onset |
Rapid progression | “wheelchair sign”: dependent < 10 years from disease onset |
Orofacial dystonia | based on clinical judgment |
Camptocormia | prolonged episodes of forward trunk flexion |
Pisa syndrome | prolonged episodes of lateral trunk flexion |
Disproportionate antecollis | severe neck flexion, minor flexion elsewhere |
Contractures of hands or feet | excluding Dupuytren’s or contracture due to other known cause |
Jerky tremor | irregular postural or action tremor of the hands and/or fingers with definite myoclonus |
Diurnal inspiratory stridor | based on clinical judgment |
Nocturnal inspiratory stridor | based on clinical judgment |
Inspiratory sighs | involuntary deep inspiratory sighs/gasps |
Severe dysphonia | based on clinical judgment |
Severe dysarthria | based on clinical judgment |
Severe dysphagia | based on clinical judgment |
REM sleep behavior disorder | intermittent loss of muscle atonia and appearance of elaborate motor activity (striking out with arms in sleep often with talking/shouting) associated with dream mentation |
Sleep apnoea | prolonged arrests of breathing |
Excessive snoring | increase from premorbid level, or newly arising |
Cold hands/feet | new development of coldness and color change – purple/blue – of extremities, with blanching on pressure and poor circulatory return |
Raynaud’s phenomenon | new emergence of painful “white fingers” |
Emotional incontinence – crying | Inappropriate crying without sadness |
Emotional incontinence – laughing | Inappropriate laughing without mirth |
Past history of documented hypertension | based on clinical judgment |