Abstract
Multiple system atrophy (MSA) remains one of the most challenging neurodegenerative disorders to diagnose, clinically characterized by various combinations of levodopa-resistant parkinsonism, cerebellar, autonomic, and pyramidal dysfunction. Early diagnosis of this disease is challenging, with post-mortem studies showing that the accuracy of diagnosis is only 62-79%. Late diagnosis is common, with an average of 3-4 years from the onset of the first symptoms to diagnosis. Given that the average survival is about 7-9 years, early diagnosis is crucial for the patient's quality of life and effective treatment. This article provides a comprehensive analysis of three distinct clinical cases (MSA-P, MSA-C, and Mixed phenotype), highlighting the critical role of the 2022 Movement Disorder Society (MDS) diagnostic criteria in refining clinical accuracy, offers a practical framework for clinicians to improve early detection and symptomatic management of MSA, ultimately aiming to enhance patient quality of life in the absence of a curative therapy.