{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:40:44Z","timestamp":1771472444069,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>This case report highlights the challenges of diagnosing MSA\u2010C in resource\u2010limited settings. MRI findings like the \u201chot cross bun\u201d sign can be supportive, but the unavailability of advanced tools like seed amplification assay may delay diagnosis. Early diagnosis is crucial for proper symptom management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Multiple system atrophy is a rare neurodegenerative disorder affecting the pyramidal, autonomic, nigrostriatal, and cerebellar tracts. Multisystem atrophy should be considered in adults with progressive motor or autonomic dysfunctions. Clinical manifestations vary depending on the system, including bradykinesia, tremor, rigidity, cerebellar ataxia, and autonomic failure. Depending on the initial predominant manifestation, multisystem atrophy is classified as Parkinsonian (MSA\u2010P) and cerebellar (MSA\u2010C). Our patient presented with progressive loss of balance, rigidity, slurred speech, choking episodes, and loss of morning tumescence for 4\u2009years, suggesting autonomic and cerebellar involvement. He was diagnosed with MSA after 4\u2009years of initial presentation with combinations of magnetic resonant imaging findings and clinical manifestations. Diagnosing multiple system atrophy in such resource\u2010limited areas is challenging. The unavailability of seed application tests and biomarkers significantly affected the delayed diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.9142","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T10:02:08Z","timestamp":1720000928000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multiple system atrophy\u2014cerebellar type: Diagnostic challenge in resource\u2010limited settings case report"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6849-1293","authenticated-orcid":false,"given":"Gebeyehu Tessema","family":"Azibte","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Addis Ababa University College of Medicine and Health Sciences  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6267-6642","authenticated-orcid":false,"given":"Bereket Abraha","family":"Molla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Addis Ababa University College of Medicine and Health Sciences  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0064-7236","authenticated-orcid":false,"given":"Sebhatleab Teju","family":"Mulate","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Addis Ababa University College of Medicine and Health Sciences  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1620-1272","authenticated-orcid":false,"given":"Selam Kifelew","family":"Melkamu","sequence":"additional","affiliation":[{"name":"Department of Neurology Addis Ababa University College of Medicine and Health Sciences  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6025-8619","authenticated-orcid":false,"given":"Zekarias Seifu","family":"Ayalew","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Addis Ababa University College of Medicine and Health Sciences  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-9121-3"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.54.3.697"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.13710"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-12093-3"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23192"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.2.384"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.5334\/tohm.166"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(03)00662-8"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2017.12.008"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/13554790590962997"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf117"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2011-301068"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22440"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radcr.2022.12.046"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.9142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T12:47:41Z","timestamp":1748350061000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.9142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":14,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1002\/ccr3.9142"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.9142","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]},"assertion":[{"value":"2024-01-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e9142"}}