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Musculoskeletal and Sports Medicine

Recurrent Falls and Autonomic Dysfunction: A Suspected Case of Shy-Drager Syndrome

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 2

    Poster Presenter(s)

  • Daniel Khokhar, DO

    Resident
    Johns Hopkins PM&R
    Baltimore, Maryland

    • Primary Author(s)

  • MR

    Michael Richmann, Other

    OMS-4
    Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
    Lakeland, Florida

    • Co-Author(s)

  • VP

    Vivek Patel, MD

    Resident Physician
    Lakeland Regional Health
    Lakeland, Florida

  • AB

    Anas Bizanti, MD

    Associate program director of internal medicine residency
    Lakeland Regional Health
    Lakeland, Florida

  • RM

    Ridhwan Mohammad, MD

    Resident Physician
    Lakeland Regional Health
    Lakeland, Florida

  • JJ

    Jacob Jernigan, DO

    Internal medicine resident
    Lakeland Regional Health
    Lakeland, Florida

Disclosure(s):
Daniel Khokhar, DO: No financial relationships to disclose
Case Diagnosis: Shy Drager Syndrome

Case Description or Program Description: Shy-Drager Syndrome, now classified under Multiple System Atrophy (MSA) with predominant autonomic dysfunction, is a rare neurodegenerative disorder characterized by parkinsonism, cerebellar ataxia, and multisystem autonomic failure. This report details the case of a 71-year-old male with a history of polyneuropathy, chronic pain, and colon cancer in remission, who was previously exposed to Agent Orange. He presented to the ED with recurrent falls, orthostatic instability, and progressive left-sided weakness. Although not officially diagnosed with Shy-Drager Syndrome, his symptoms raised suspicion for the condition. This case underscores the importance of early recognition of neurodegenerative disorders, particularly in individuals with exposure to toxic environmental agents.

Setting: Inpatient Acute Care

Assessment/Results: Presumed Diagnosis of Shy Drager Syndrome and rehab recommendations given

Discussion (relevance): The patient’s symptoms align with Multiple System Atrophy (MSA) with autonomic dysfunction, featuring parkinsonism, autonomic failure, and cerebellar ataxia. Agent Orange exposure supports this likelihood, though chemotherapy-induced neuropathy remains a consideration. MSA diagnosis is challenging due to symptom overlap and a lack of biomarkers, requiring extensive clinical evaluation. Management focuses on symptom relief, physical conditioning, and autonomic support.

Conclusions: This case highlights the diagnostic complexity of rare neurocognitive disorders such as Multiple System Atrophy with predominant autonomic dysfunction, commonly referred to as Shy-Drager Syndrome. The addition of multiple risk factors such as exposure to Agent Orange and chemotherapy complicate the diagnosis further. Although MSA is the leading theory, alternative etiologies such as chemotherapy-induced polyneuropathy cannot be ruled out at this time. Further diagnostic testing such as nerve conduction studies and autonomic function testing would help clinicians hone in on a diagnosis, but unfortunately they have not been performed yet in this patient. Additionally, even if MSA was properly diagnosed, no definitive cure exists at this time, so the patient would mostly be getting treatment for symptomatic relief, which they are already getting.