Brain Magnetic Resonance Imaging in Multiple-System Atrophy and Parkinson Disease

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Abstract
MULTIPLE-SYSTEM atrophy (MSA) and Parkinson disease (PD) are the 2 most prevalent neurodegenerative disorders that exhibit features of parkinsonism and autonomic dysfunction. Many patients with MSA have, in addition to parkinsonism, cerebellar ataxia, and this combination is referred to as MSA-C. In the most frequent type of MSA, referred to as MSA-P, patients have mostly parkinsonian and few, if any, cerebellar signs.1 Accordingly, the clinical distinction between MSA-P and PD is often difficult. Clinical history may be helpful because, in patients with MSA-P, symptoms of autonomic failure frequently precede parkinsonism but, not infrequently, parkinsonism is the presenting feature. Complicating matters further, although patients with PD usually present with parkinsonism, they may also have severe autonomic failure in a later phase of the disease, making the distinction from MSA-P extremely difficult. The availability of new surgical and pharmacologic therapies that may be effective only in patients with PD has heightened the need for precise diagnosis.