neurologic disorders
Multiple System Atrophy (MSA)
Introduction
Multiple system atrophy is a relentlessly progressive neurodegenerative disorder causing pyramidal, cerebellar, and autonomic dysfunction. It includes 3 disorders previously thought to be distinct: olivopontocerebellar atrophy, striatonigral degeneration, and Shy-Drager syndrome. Symptoms include hypotension, urinary retention, constipation, ataxia, parkinsonism, and postural instability. Diagnosis is clinical. Treatment is symptomatic, with volume expansion, compression garments, and vasoconstrictor medications. (See also Overview of the Autonomic Nervous System .) Multiple system atrophy affects men and women equally. Mean age at onset is about 53 years; after symptoms appear, patients live about 9 to 10 years. There are 2 types of multiple system atrophy (MSA); types are based on the initial symptoms that predominate: MSA-C: Characterized by ataxia and postural instability ( Cerebellar Disorders ) ( Symptoms and Signs ) Both types involve autonomic nervous system dysfunction. Although multiple system atrophy begins as one type, symptoms of the other type eventually develop. After about 5 years, symptoms tend to be similar regardless of which disorder developed first. 