Multiple system atrophy (MSA) is an adult-onset, sporadic, progressive neurodegenerative disease characterized by varying severity of parkinsonian features, cerebellar ataxia, autonomic failure, urogenital dysfunction, and corticospinal disorders. MSA is a complex disease with considerable diagnostic challenges to doctors and medical researchers, in this context, we present a differential diagnosis of MSA.

Multiple system atrophy affects three main areas of the nervous system such as Substantia Nigra: motor portion of the brain where Parkinson’s disease (PD) originates  Cerebellum: balance and coordination centers of the brain Autonomic division: regulates automatic activities such as blood pressure, heart rate, sexual function, digestion and elimination Bladder dysfunction and male erectile dysfunction (ED) are the frequent initial manifestation of MSA. In some patients, parkinsonism…