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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 anti-parkinsonian 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 PD with <jats:italic>\u03b1<\/jats:italic>-synuclein pathology in the Onuf\u2019s nucleus (ON).<\/jats:p>","DOI":"10.1136\/bcr.08.2008.0774","type":"journal-article","created":{"date-parts":[[2009,2,2]],"date-time":"2009-02-02T06:49:47Z","timestamp":1233557387000},"page":"bcr0820080774","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Parkinson\u2019s disease with Onuf\u2019s nucleus involvement mimicking multiple system atrophy"],"prefix":"10.1136","volume":"2009","author":[{"given":"Sean Stephen","family":"O\u2019Sullivan","sequence":"first","affiliation":[{"name":"Queen Square Brain Bank, Department of Molecular Neuroscience, Institute of Neurology, University College London, London, WC1N 1PJ, UK"},{"name":"University College London, Reta Lila Weston Institute, 1 Wakefield Street, London, WC1N 1PJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke A","family":"Massey","sequence":"additional","affiliation":[{"name":"Queen Square Brain Bank, Department of Molecular Neuroscience, Institute of Neurology, University College London, London, WC1N 1PJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Williams","sequence":"additional","affiliation":[{"name":"Queen Square Brain Bank, Department of Molecular Neuroscience, Institute of Neurology, University College London, London, WC1N 1PJ, UK"},{"name":"Faculty of Medicine (Neurosciences), Monash University (Alfred Hospital Campus), Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamas","family":"Revesz","sequence":"additional","affiliation":[{"name":"Queen Square Brain Bank, Department of Molecular Neuroscience, Institute of Neurology, University College London, London, WC1N 1PJ, 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