Signs and symptoms of multiple system atrophy (MSA) vary, depending on the MSA type involved. In addition, even within specific MSA types, symptoms may vary from person to person. Symptoms of MSA can appear in a wide variety of combinations.

Signs and symptoms of striatonigral degeneration (SND) resemble that of Parkinson’s disease and may include:

• Slowed movements
• Rigidity
• Shuffling gait
• Impaired balance and speech
• Deterioration in fine motor skills
• Tremors

Signs and symptoms of olivopontocerebellar atrophy (OPCA) may include:

• Loss of balance and muscle coordination (ataxia) of legs and arms
• Speech difficulties (e.g., slurred speech)
• Muscle spasms
• Weakness or stiffness of muscles
• Numbness or tingling in the hands and feet
• Abnormal eye movements
• Tremors in the hands or arms
• Cognitive disorders, including memory loss
• Impaired ability to pay attention
• Bowel- or bladder-control problems
• Fatigue
• Trouble sleeping

Multiple system atrophy with orthostatic hypotension (formerly known as Shy-Drager syndrome) usually causes orthostatic hypotension. This is a sudden and excessive drop in blood pressure when a patient changes position, particularly when going from a lying or seated position to standing. Orthostatic hypotension can result in dizziness or fainting that may cause patients to fall and possibly injure themselves. This type of MSA is also sometimes referred to as the combination type because it may include symptoms typically seen with OPCA or SND. Additional symptoms of this type of MSA may include:

• Urinary incontinence
• Constipation
• Erectile dysfunction (in men)
• Generalized weakness
• Vision problems (e.g., double vision)
• Decreased ability to sweat
• Difficulty breathing or swallowing