Let’s get real — Multi-System Atrophy (MSA) is one of those diagnoses that makes med students panic, neurologists smirk, and internal medicine doctors quietly pretend to “refer to neuro.” 😅
But the truth is, MSA isn’t rare, especially in our practice in Quetta, where we often see patients from places like Kharan or Zhob with chronic gait issues, bizarre autonomic signs, and Parkinsonian features that don’t quite fit the idiopathic PD mold.
So how do I remember the classic triad of MSA?
Well, brace yourself for a mnemonic that’s memorable, if not morally uplifting:
🧠 Multi-System Atrophy – Mnemonic Table
Mnemonic: “Please Straighten Any Shy Cunts Out”
| Mnemonic Phrase | Clinical Feature | Pathology/Subtype |
|---|---|---|
| Please / Straighten | Parkinsonism | Striatonigral Degeneration (MSA-P) |
| Any Shy | Autonomic failure | Shy-Drager Syndrome (MSA-A) |
| Cunts Out | Cerebellar ataxia | Olivopontocerebellar Atrophy (MSA-C) |
⚠️ Clinical Note: Yes, the mnemonic is profane — but it’s brutally effective. And when you’re staring down a 150-question FCPS/PLAB/USMLE block with 4 hours of sleep, utility > politeness. Just don’t say it in front of your attending. Or your mum.
🏥 MSA in Practice: A Case from Washuk
I once saw a 58-year-old schoolteacher from Washuk who presented with a weird mix:
- Slurred speech
- Tremor that didn’t respond to Levodopa
- BP of 80/40 when standing
- Wide-based gait like he was walking on a ship
Dr. Basit Khan suspected MSA. Dr. Behroz Rahim ruled out a psychiatric overlay. I ordered an MRI — classic “hot cross bun sign” in the pons.
Diagnosis? MSA-C with autonomic features.
The mnemonic rang in my head immediately: Parkinsonism, Autonomics, Cerebellar Ataxia — the trifecta.
Happy learning, folks! 🙂
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