A Case Study of International Medical Consultation - Published by Aurora Health Intelligence
Recently, a patient from Shanghai achieved remarkable results through an international remote consultation facilitated by Aurora Health Intelligence (AHI). Here is a brief overview of the case.
Mr. Wu, the patient, first visited a local hospital in Shanghai three years ago due to "numbness in the right lower limb and unsteady walking." An MRI scan of his brain revealed "reduced volume of the brainstem and cerebellar hemispheres, with a 'cross' sign in the pons, and localized enlargement of the sulci, cisterns, and ventricles." The initial diagnosis was "neurological lesions." From January 2022 to November 2022, Mr. Wu frequently visited a renowned hospital in Shanghai for "stiffness in the right limbs, slow movements, occasional pain and numbness," along with symptoms such as "slurred speech, memory decline, writing difficulties, frequent urination, urgency, constipation, sexual dysfunction, and anxiety." He denied any family history of these conditions, though his mother was diagnosed with Parkinson's disease at the age of 70 (currently living independently). Subsequently, Mr. Wu was diagnosed with "Parkinson's disease and Multiple System Atrophy (MSA)." Since February 2022, he has been treated with medications such as amantadine and biperiden. In November 2022, he was admitted for a comprehensive evaluation and diagnosed with: 1. Cerebellar ataxia (considering MSA), 2. Hyperhomocysteinemia, 3. Thyroid nodules, and 4. Fatty liver.
Since late 2021, Mr. Wu has undergone annual MRI follow-ups to assess brain progression. Each scan showed "reduced volume of the brainstem and cerebellar hemispheres, with a 'cross' sign in the pons, localized enlargement of the sulci, cisterns, and ventricles. The cerebral hemispheres were symmetrical, and the morphology, structure, and signal of the brain parenchyma remained normal at all levels." The radiological diagnosis was "brainstem and cerebellar atrophy" (see Figures 1 and 2).
2021
2024
For the past three years, Mr. Wu has continuously taken a series of medications, including levodopa, biperiden, madopar, amantadine, methylcobalamin, idebenone, rasagiline, and pyridostigmine bromide. However, his symptoms have progressively worsened, evolving from a forward-leaning posture to a side-to-side sway, slurred speech, anxiety, urinary retention, constipation, and the recent placement of a urinary catheter, significantly reducing his quality of life. Seeking further help, Mr. Wu and his family arranged an international consultation through Aurora Health Intelligence.
The consultation was conducted by an expert team from the Neurology Department at the Southwestern Medical Center in the USA, led by Dr. Steven Vernino. Southwestern Medical Center boasts seven Nobel laureates and ranks among the top 20 hospitals in the US, holding the number one spot in Texas. Its neurology department is highly acclaimed. Dr. Steven Vernino, Vice Chair of Neurology, is a distinguished expert in neuromuscular diseases and MSA. He has served as President of the American Autonomic Society, published over 140 academic papers, and specializes in diagnosing and treating autoimmune neurological disorders, autonomic diseases, and neuromuscular conditions, with extensive clinical experience and high patient satisfaction.
After thorough preparation, including collecting and translating the patient's medical history, transmitting test results, and uploading original imaging results, as well as detailing the patient's medication and other treatments, Mr. Wu was assessed by Dr. Vernino's multidisciplinary team (MDT) at Aurora Health Intelligence. A one-hour video consultation was conducted, during which the team addressed numerous questions from Mr. Wu and his family, offering precise diagnostic and treatment guidance.
The consultation focused on addressing Mr. Wu's concerns about his diagnosis over the past three years and the effectiveness of his treatment. Based on extensive experience with other patients and the latest international research, Dr. Vernino concluded:
The differences in the patient's brain MRI results over three years are minimal and insufficient as a basis for disease progression.
The previous diagnosis of "Parkinson's disease" and treatment with levodopa and similar drugs were ineffective, with symptoms continuing to worsen. Based on clinical manifestations and review, Mr. Wu's diagnosis should be "Parkinsonian-type Multiple System Atrophy (MSA),” which fundamentally differs from traditional Parkinson's disease. MSA, also known as Shy-Drager syndrome, is a rare neurodegenerative disease affecting the brainstem, olive, and striatum, causing cerebellar atrophy or substantia nigra degeneration. It further involves the autonomic nervous system, leading to clinical manifestations similar to Parkinson's disease, such as bradykinesia, muscle rigidity, and balance issues, along with blood pressure, urinary, gastrointestinal, sweating, sleep, sexual, cardiovascular, and psychiatric symptoms. Mr. Wu's clinical presentation aligns closely with MSA, and Dr. Vernino's authoritative evaluation significantly aids in differential diagnosis.
Due to the severity of the patient's condition, treatment should focus more on symptom management. Building patient confidence and family support is crucial for prognosis.
Dr. Vernino's team is prepared to offer the patient the latest clinical trial opportunities. Ongoing trials focus on MSA's molecular-targeted proteins, with more targeted drug trials expected in the coming months.
In summary, the patient highly appreciated the international consultation, expressing profound gratitude (see Figures 3, 4, 5). This experience bolsters our confidence and hope in providing precise and cutting-edge treatment to more patients in need.