Multiple system atrophy

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Central nervous system

Multiple system atrophy

Alternative Names:

Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome
Symptoms:

Dizziness or fainting when arising or after standing still
Impotence
Loss of sweating of any part of the body
Loss of control of bowels or bladder
Vision changes, decreased or blurred vision
Muscle rigidity
- Stiffness
- Difficulty bending arms or legs
Posture difficulties: may be unstable, stooped, or slumped over
Movement difficulties
- Loss of balance
- Gait (walking pattern) changes
- Shuffling
Slow movements
- Difficulty beginning to walk or initiating any voluntary movement
- Small steps followed by the need to run to maintain balance
- Freezing of movement when the movement is stopped, unable to resume movement
Muscle aches and pains (myalgia)
Tremors: may be present in varying degrees or may not be present
- May occur at rest or at any time
- May become severe enough to interfere with activities
- May be worse when tired, excited, or stressed
- Finger-thumb rubbing (pill rolling tremor): may be present
- May occur with any action such as holding a cup or other eating utensils
Changes in facial expression
- Reduced ability to show facial expressions
- "Mask" appearance to face
- Staring
- May be unable to close mouth
Voice and/or speech changes
- Slow speaking
- Voice is low-volume
- Monotone
- Difficulty speaking
Difficulty chewing or swallowing (occasionally)
Loss of fine motor skills
- Difficulty writing: may be small and illegible
- Difficulty eating
- Difficulty with any activity that requires small movements
Frequent falls
Mild decline in intellectual function (may occur)

Additional symptoms that may be associated with this disease:

Depression
Confusion
Dementia
Seborrheic dermatitis
Sleep-related breathing difficulties, especially sleep apnea and air passage obstruction accompanied by a harsh vibrating sound

Signs and tests:

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The health care provider may perform the following:

Eye examination: may reveal atrophy of the iris and paralysis of eye muscles.
Neuromuscular examination:
- Shows abnormal reflexes
- May show severe muscle wasting (atrophy)
Blood pressure measurement: may reveal postural hypotension (drop in blood pressure associated with change in position)

Parkinsonian movements (tremor, rigidity, and slow movements similar to Parkinson's disease) are common.

There are no specific tests to confirm this disease. A neurologist can make the diagnosis based on the history of symptoms, the findings during physical examination, and ruling out other causes of symptoms.

Testing to help confirm the diagnosis may include the following:

Plasma norepinephrine levels
Urine examination for norepinephrine breakdown products (urine catecholamines)
MRI of head to rule out other pathology. There are no specific abnormalities on imaging associated with MSA