A 67 years old female developed cognitive deficits, depression and anxiety as first symptoms of multiple system atrophy (MSA). In the course of an year autonomic failure, parkinsonism and cerebellar ataxia also developed. The case is particular because of the somatic symptoms that were initially categorized as psychogenic, the presence of confusional and vertigo episodes that were recurring but not permanent.

Renal thromboembolism is a rare, but severe condition in non-valvular paroxysmal atrial fibrillation, that could remain underdiagnosed. Due to atrial fibrillation the embolus is organized in left atrium and auricle then reach the renal artery with subsequently ischemia. Renal colic could mimic multiple pathologies as nephrolithiasis, pyelonephritis, kidney ischemia, diverticulitis, sub-occlusive intestinal syndrome, ruptured abdominal aortic aneurysm. [...]