Multiple system atrophy (MSA) is a sporadic, neu-rodegenerative disorder, characterized by several combinations of parkinsonian, autonomic, cerebel-lar and pyramidal signs1-5. The incidence is 0.6 cas-es/100000/year and the prevalence ranges from 1.86 to 4.9 cases/1000001. The term MSA defines a distinct clinicopathological entity, including olivopontocere-bellar atrophy, striatonigral degeneration and Shy-Drager syndrome, which have been described as dif-ferent diseases for many years and still lead to termi-nology confusion. The actual consensus tries to de-fine the diagnostic criterions and recommends the term MSA-P when parkinsonian features predomi-nate, and the term MSA-C when cerebellar signs rules the clinical picture. There is some doubt if the term Shy-Drager syndrome should be substitute, as most cases of MSA patients develop autonomic dysfunc-tion during their course6. Horimoto et al.7 believe that some patients present a distinct form of MSA in which dysautonomic symptoms predominate, con-sidering the utility to classify that form as MSA-A. Recently, neuroimaging studies, especially the MRI, have showed some alterations that, although not specific, may help the diagnostic of different forms of MSA. We report two MSA cases with different clinical features and their characteristic MRI alterations

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