The study concluded that these repeats were absent in pathologically confirmed MSA, suggesting an alternative genetic cause. Pathophysiology
Multiple system atrophy can be explained as cell loss and gliosis or a proliferation of astrocytes in damaged areas of the central nervous system. This damage forms a scar which is then termed a glial scar. The presence of inclusion bodies known as Papp–Lantos bodies, in the movement, balance, and autonomic-control centres of the brain are the defining histopathologic hallmark of MSA.The major filamentous component of Papp-Lantos bodies, glial and neuronal cytoplasmic inclusions, is alpha-synuclein. Mutations in this substance may play a role in the disease. The conformation of the alpha-synuclein is different from that of alpha-synuclein in Lewy bodies. The disease probably starts with an oligodendrogliopathy.Tau proteins have been found in some glial cytoplasmic inclusion bodies. Diagnosis
Clinical
Clinical diagnostic criteria were defined in 1998  and updated in 2007. Certain signs and symptoms of MSA also occur with other disorders, such as Parkinsons disease, making the diagnosis more difficult. Radiologic
Both MRI and CT scanning may show a decrease in the size of the cerebellum and pons in those with cerebellar features (MSA-C). The putamen is hypointense on T2-weighted MRI and may show an increased deposition of iron in the Parkinsonian (MSA-P) form.
Macrotia refers to an ear that is larger than would be expected. The normal auricular axis length is 58–62 mm (2.3–2.4 in) among females and 62–66 mm (2.4–2.6 in) among males. The average width of an adult ear, specifically the distance between the helix root (inner front edge) and the posterior auricle (outer front edge), is between 30 and 40 mm (1.2 and 1.6 in). Treatment for Macrotia
Macrotia is an external ear malformation and is not known to cause any hearing impairment on its own, although it may occasionally occur simultaneously with other developmental disorders that do affect hearing. Treatment is typically not necessary, although patients may seek cosmetic treatment. In some cases, surgery (otoplasty) is performed to reduce the ear size. While generally considered a cosmetic procedure, otoplasty for macrotia can improve overall quality of life, especially for young patients who may be able to avoid reduced self-esteem and social avoidance behavior due to large ears. Otoplasty for macrotia typically focuses on reducing the size of the scapha, which is the concave region of the ear between the helix and antihelix ridge, while preserving ear shape and contour. References


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