Conflicting diagnoses; what to do?

Posted By Clydie Wakefield on September 30, 1998 at 15:52:54:







My 81-yea- old mother was diagnosed (by a cardiologist) as having multiple system atrophy---he said that it wasn't Shy Drager (what is the difference--I thought multiple system atrophy was just a more modern term for Shy Drager) but that it involved multiple systems and it was cerebellar.  He also pointed out that she has sick sinus syndrome and that one problem makes the other one worse.  He didn't think a pacemaker was warranted, because of the MSA; but prescribed Norpace.
Her symptoms:  She failed the tilt table test  (on the third time she was lifted up with the addition of that drug that similates adrenalin).  During the tilt table test we observed a very erratic heart beat even as she was horizontal.  She has difficulty keeping her balance (has resorted to a walker) and has spells/episodes that seem stroke-like or  like she is going to faint--she doesn't faint and these episodes seem independent of posture.   She seems to have greater difficulty expressing herself--finding the words and her voice volume is reduced.  She does have double vision.  She was in great health a liitle more than a year ago, and now has discontinued driving and reduced her activity quite dramatically.  She appears quite normal, except that she is somewhat fragile and is unsteady on her feet.  No Parkinsonion symptoms--shaking, etc.  Her handwriting has become increasingly difficult to read, she has lessened use of her right side (not obvious, but when she sits in the car, she lifts her right leg with her hands). A head CT revealed some atrophy and she is mildly forgetful--(when we were at the cemetary, claimed that her parents weren't buried there, but in another town), but recognizes everyone.
The neurologist, on the other hand, diagnosed her as having neurocardiagenic syncope (sp).  But to eliminate the possibility of stroke, he prescribed a blood-thinner (Kumodon), but her "spells" did not decrease, so that was discontinued.  
So now we are at an impasse, and I'm not certain where to proceed.  Should we get a second opinion from a neurologist?  Why isn't a pacemaker warranted?  Is this what early MSA looks like?