. Author manuscript; available in PMC: 2018 May 21.

Published in final edited form as: Semin Neurol. 2017 May 16;37(2):215–227. doi: 10.1055/s-0037-1602422

Table 5.

Differentiating features of MSA-P and MSA-C from PD (“Red flags”)

MSA-P	MSA-C
Symmetrical onset	Cerebellar limb, gait ataxia
Rapid symptom progression	Early gait instability, falls
Jerky, myoclonic, postural/action tremor	Dysarthria (scanning, ataxic)
Contractures of hands and feet	Dysphagia
Anterocollis, axial dystonia (camptocormia ± lateral flexion, or Pisa syndrome)	Gaze impairment (hypo/hyperkinetic saccades)
Early gait difficulty, falls	Lower and upper motor neuron signs
Severe dysphonia, dysarthria	Emotionality, depression, anxiety
New/increased snoring, sleep apnea	Progressive dementia
Respiratory/laryngeal stridor	No family history of ataxia or parkinsonsism
Hyperreflexia, Babinski’s
Pseudobulbar affect (emotional lability)
Cold hands/feet
Dysautonomia (69% vs 5% in PD)
Poor/unsustained levodopa response (~30%)
Orofacial dyskinesia/dystonia

(Reprinted with permission from McFarland NR. Diagnostic Approach to Atypical Parkinsonian Syndromes. Continuum 2016;22(4):1134. doi: 10.1212/CON.0000000000000348)