The initial symptoms of multiple system atrophy (MSA) are often difficult to distinguish from the initial symptoms of Parkinson's disease and include:
- Fainting or lightheadedness due to orthostatic hypotension, a condition in which blood pressure drops rapidly when rising from a seated or lying down position
- Bladder control problems, such as a sudden urge to urinate, difficulty in emptying the bladder completely, or, for men, difficulty in achieving an erection
- Clumsiness, loss of balance, and frequent falls
- Slurred speech, a croaky, quivering voice, or difficulty in swallowing
- Decreased spontaneous movement, tremors, or rigid muscles
Doctors divide MSA into two different types, depending on the most prominent symptoms at the time an individual is evaluated:
- The parkinsonian type (MSA-P) has primary characteristics of Parkinson's disease, such as slow movements, stiff muscles, and tremors, along with problems of balance, coordination, and autonomic nervous system dysfunction.
- The cerebellar type (MSA-C) has primary symptoms featuring difficulty in swallowing, slurred speech, or a quavering voice, along with ataxia (problems with balance and coordination).
Additional symptoms of MSA include:
- Contractures in the hands or feet that prevent the joints from moving freely
- Pisa syndrome, an abnormal posture in which the body appears to be leaning to one side, like the Leaning Tower of Pisa
- Disproportionate antecollis, in which the neck bends forward and the head drops down
- Deep, uncontrollable sighing or gasping Inappropriate laughing or crying.