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)