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Multiple System Atrophy Evaluation Methods

A thorough history and clinical neurologic evaluation form the foundation upon which your doctor will make important recommendations for further testing procedures. Evaluation may be an ongoing process as symptoms and treatments progress and can include a wide range of imaging, laboratory and other testing procedures. Providing your doctor with the most accurate and complete symptom and health history information to the best of your ability will help ensure you receive the most efficient and precise diagnostic care.


Magnetic resonance imaging (MRI) is a form of imaging that is used to detect changes in the brain. Individuals with MSA may find that an MRI is useful for diagnosis, but it is not clearly needed on a yearly basis to track the disease progression. MRI can be used to differentiate between MSA-P and Parkinson’ Disease, especially by looking for certain changes in the brain stem, or putamen. Due to its significant role in diagnosing MSA, MRI is considered a diagnostic tool1.

PET Scan

Positron emission tomography, also known as PET, is an imaging technique that records brain activity. Physicians may use this imaging modality to better their diagnosis as certain neurologic disease impact specific parts of the brain, leading to decreased function in those areas2.


A transcranial ultrasound may be used by your physician to look at a part of the brain stem responsible for releasing a neurotransmitter called dopamine3.

Autonomic Testing

The autonomic nervous system controls various aspects of the body such as heart rate, blood pressure, bladder, and sexual function. In Multiple System Atrophy, individuals may have an impaired autonomic nervous system, leading to dysautonomia, and are tested in a noninvasive manner. One of the possible findings includes a blood pressure drop of >20 mmHg (or >30 mmHg for certain labs) systolic from sitting to standing, known as orthostatic hypotension4. There are several different ways the autonomic nervous system can be tested, but the most common is the tilt table test, where the blood pressure and heart rate will be assessed lying down, then in the raised position. Attention to the beat-to-beat variability and how the heart beat changes when the person holds their breath is another way to see the integrity of this system.

Blood Tests

A blood sample may help differentiate MSA from pure autonomic failure (PAF) and Parkinson’s disease. Individuals with MSA have near normal levels of a neurotransmitter called norepinephrine, which is used in the autonomic nervous system. This chemical is often decreased in PAF, and is used in some centers for diagnosis of PAF (peripheral)5. There are no diagnostic blood tests for MSA at present.

Clinical Exam

Many neurodegenerative diseases are diagnosed clinically. The clinical exam should include a thorough neurological exam that consists of testing cranial nerves, reflexes, memory, coordination, movement, and speech. A neurologist may use various standardized questionnaires to improve diagnostic assessment. This is the best method for monitoring change over time of the patient.

For all references listed in the About MSA section please download the MSA Coalition's "MSA - What You Need to Know"

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