title: Sensory neuropathy as the initial manifestation of multiple system atrophy.
abstract: Peripheral neuropathy is usually subtle or subclinical in patients with multiple system atrophy (MSA). A 54-year-old man who initially presented with sensory polyneuropathy developed extrapyramidal and cerebellar signs and autonomic failure typical of MSA 7 years later. Sural nerve biopsy disclosed a prominent loss of large myelinated fibers, whereas the unmyelinated fibers were totally spared. These findings imply that sensory neuropathy can be part of the multiple-site degeneration in MSA, and that predominant involvement of large myelinated fibers of the sensory nerves can be a presenting feature.
authors.affiliation: Second Department of Neurology, Chang Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan.
authors.forename: Yih-Ru
authors.initials: YR
authors.lastname: Wu
authors.forename: Chiung-Mei
authors.initials: CM
authors.lastname: Chen
authors.forename: Long-Sun
authors.initials: LS
authors.lastname: Ro
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
authors.forename: Lok-Ming
authors.initials: LM
authors.lastname: Tang
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis*; D011115:Polyneuropathies / Q000209:etiology*; D012678:Sensation Disorders / Q000209:etiology*