Multiple system atrophy (MSA) is an adult-onset, sporadic neurodegenerative disease with varying degrees of autonomic dysfunction, Parkinson’s syndrome with poor response to levodopa-like drugs, cerebellar ataxia, and pyramidal fasciculations. The clinical manifestations vary because of the different sequences of involvement of these three systems at the onset of the disease. Shy-Drager syndrome (SDS), striatonigral degeneration (SND), and olivopontocerebellar atrophy (OPCA) are the three types of SDS. The main manifestations are: cerebellar ataxia, Parkinson’s syndrome, and autonomic dysfunction.