How is multiple system atrophy (MSA) diagnosed?

Updated: Oct 17, 2018
  • Author: André Diedrich, MD, PhD; Chief Editor: Selim R Benbadis, MD  more...
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Multiple system atrophy (MSA) is a difficult diagnosis, especially early in the clinical course, and the initial physician often misdiagnoses the condition. The most common initial diagnosis is idiopathic Parkinson disease.

The diagnosis of MSA is based mainly on clinical features (see tables 2a, 2b, 3, and 4). The presence of MSA can be definitively established only on postmortem examination. MSA is confirmed by the presence of a high density of glial cytoplasmic inclusions (GCIs) in association with degenerative changes in the striatonigral and olivopontocerebellar pathway.

In a patient with autonomic failure and orthostatic hypotension, the combination of a normal supine norepinephrine level that does not rise significantly with upright position suggests MSA.

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