Multiple system atrophy

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Central nervous system

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

• 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 speech changes
  • Slow speaking
  • Voice is low volume
  • Monotone
  • Difficulty speaking
• Difficulty chewing or swallowing (occasionally)
• Loss of fine motor skills
  • 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)

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

The health care provider may perform the following:

• Eye examination
• Neuromuscular examination
• Blood pressure measurement

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 by ruling out other causes of symptoms.

Testing to help confirm the diagnosis may include:

• Plasma norepinephrine levels
• Urine examination for norepinephrine breakdown products (urine catecholamines)
• MRI of head to rule out other conditions

Review Date: 11/21/2006
Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.