Parkinson’s disease with Onuf’s nucleus involvement mimicking multiple system atrophy

Sean S O'Sullivan ¹, Janice L Holton ², Luke A Massey ², Laura Silveira-Moriyama ², David R Williams ³, Tamas Revesz ² and Andrew J Lees ^2*

¹ Reta Lila Weston Institute of Neurological Studies, United Kingdom
² Queen Square Brain Bank, Institute of Neurology, United Kingdom
³ Monash University (Alfred Hospital Campus), Australia

^* To whom correspondence should be addressed. E-mail: alees{at}ion.ucl.ac.uk.

Accepted 12 October 2007

Abstract

Urinary frequency, urgency and nocturia are common complaints in Parkinsons disease. The hypothesis most widely proposed to explain neurogenic bladder symptoms in PD is that cell loss in the substantia nigra may cause detrusor hyperactivity due to a loss in the D1 receptor-mediated tonic inhibition of the micturition reflex, although other causes including antiparkinsonian medication cortical effects have been considered.[1] We present the clinical and pathological findings of a patient with Parkinsonism who presented with prominent dysautonomia and a poor response to dopaminergic medications and was considered to have possible multiple system atrophy-Parkinsonism (MSA-P). Pathological examination revealed that the patient had Parkinson’s disease with alpha synuclein pathology in Onuf’s nucleus (ON).

Keywords: neurogenic bladder, onuf, parkinson disease

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