A 60yo man was brought in by his wife complaining of ataxia, urinary incontinence and erectile
dysfunction. He also complains of rigidity and slowing of movement with a pill rolling tremor of
the hands. What is the likely dx?
a. Parkinson’s disease
b. Idiopathic parkinson’s disease
c. Shy-drager syndrome
d. Huntington’s disease
Ans. The key is C. Shy-drager syndrome. [Shy-drager syndrome is characterized by parkinsonism (rigidity, slowing of movement with hand tremors) plus a more pronounced failure of the autonomic nervous system (urinary incontinence and erectile dysfunction) and there may also cerebellar sign like ataxia be present]. [Please note the discrepancy of this question (may be a bad recall) that classic pill rolling movement is not a feature of multiple system atrophy (shy-drager dsyndrome)].