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Multiple system atrophy

  • Alternative Names

    Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome; MSA-P; MSA-C


    Symptoms

    MSA damages the nervous system, which can cause the following symptoms:

    • Changes in facial expression
      • "Mask" appearance to face
      • May be unable to close mouth
      • Reduced ability to show facial expressions
      • Staring
    • Difficulty chewing or swallowing (occasionally)
    • Disrupted sleep patterns (especially during rapid eye movement (REM) sleep late at night)
    • Dizziness or fainting when standing up or after standing still
    • Frequent falls
    • Impotence
    • Loss of control over bowels or bladder
    • Loss of fine motor skills
      • Difficulty eating
      • Difficulty with any activity that requires small movements
      • Writing that is small and hard to read
    • Loss of sweating in any part of the body
    • Mild decline in mental function (may occur)
    • Movement difficulties
      • Loss of balance
      • Shuffling
      • Walking pattern (gait) changes
    • Muscle aches and pains (myalgia)
    • Muscle rigidity
      • Difficulty bending arms or legs
      • Stiffness
    • Nausea and problems with digestion
    • Posture difficulties: may be unstable, stooped, or slumped over
    • Slow movements
      • Difficulty beginning to walk or starting any voluntary movement
      • Freezing of movement when the movement is stopped, unable to start moving again
      • Small steps followed by the need to run to keep balance
    • Tremors
      • May become severe enough to interfere with activities
      • May be worse when tired, excited, or stressed
      • May occur at rest or at any time
      • May occur with any action, such as holding a cup or other eating utensils
      • Finger-thumb rubbing (pill rolling tremor)
    • Vision changes, decreased or blurred vision
    • Voice and speech changes
      • Difficulty speaking
      • Monotone
      • Slow speaking
      • Voice is low volume

    Other symptoms that may occur with this disease:

    • Confusion
    • Dementia
    • Depression
    • Sleep-related breathing difficulties, especially sleep apnea or a blockage in the air passage that leads to a harsh vibrating sound

    Signs and tests

    The health care provider may perform the following:

    • Blood pressure measurement, lying and standing
    • Eye examination
    • Nerve and muscle (neuromuscular) examination

    There are no specific tests to confirm this disease. A neurologist can make the diagnosis based on:

    • History of symptoms
    • Findings during a physical examination
    • Ruling out other causes of symptoms

    Testing to help confirm the diagnosis may include:

    • MRI of head
    • Plasma norepinephrine levels
    • Urine examination for norepinephrine breakdown products (urine catecholamines)