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54-year-old Jacque Depot, a truck driver who was active, worked out regularly and was in good health, began experiencing occasional impotence. Additionally, he was experiencing urinary problems, where he felt enormous urgency to urinate, but had difficulty producing a urinary stream. Embarrassed, he ignored these symptoms, dismissing them as part of aging. It wasn’t until he arose from bed one morning and fainted that he made an appointment with his doctor. By the time he saw his physician, he had been feeling dizzy every morning for a month and had an array of symptoms that convinced him something was seriously wrong. In addition to impotence, urinary problems and dizziness when he stood up, he had double vision, indigestion, diarrhea, and heat intolerance.
Jacque was referred to a neurologist who ran a battery of tests. In the end, he was diagnosed with Multiple System Atrophy (MSA).
Answer the following questions:
1. What is MSA? Which organ systems would you expect to be adversely affected by this disease?
2. Describe the autonomic control of micturition (urination), including the functions of the detrusor muscle and the sphincters of the bladder. Why did Jacque experience urinary urgency, but was then unable to void normally?
3. Why was he heat intolerant?
4. A distinguishing characteristic of MSA is orthostatic hypotension. What is orthostatic hypotension? Why does this NOT occur in healthy individuals (explain the activity of the ANS that prevents it)? Why were these responses impaired in Jacque?