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Objective: Multiple system atrophy (MSA) is a sporadic, progressive, adult-onset disorder associated with varying degrees of parkinsonism, autonomic dysfunction, and cer- ebellar ataxia.Methods: We analyzed the initial symptoms, clinical features and brain at warp measurement of 55 patients with MSA ,retrospectively ,in ordering to increase the diagnosis rate of MSA in early stage, and improve the quality of life and prolong life. A total of 55 patients with MSA were colletcted from first affiliated hospital of Dalian medical university during January 2005 to December 2010,the diagnose of MSA was made according to the Gilman criteria and all patientes were underwent MRI.According to the Gilman criteria,we divided 55 cases into three types, MSA - C (n=33), MSA - P (n=13), MSA - type A (n=8), through comparing the initial symptoms, clinical features the cerebellum characteristics, extrapyramidal signs, the signs and symptoms of autonomic function, the cone bunch of levy) and brain at warp measuring brain atrophy degree (T1, T2) of anteroposterior and transverse diameters of putamen,globus pallidus, midbrain,pons,fourth ventricle,medulla oblongata,widths of superior and midcerebellar peduncles,diameters of dentate and red nuclei,Using column of three subtypes contingency table for the clinical manifestations of the description and the statistical by histogram of each subtypes of clinical manifestations are the direct the percentage of T test, compared with that by using the subsets of parenchymal and fourth ventricle brain at warp measurement for binary comparison, mean A significant level of 0.05, A judge no exist significant differences. The data are used SPSS16.0 statistical packages by statistical analysis.Results: MSA-C patients first signs for dizziness and pose instability, 35.3%、29.4%respectively, of the nasal 9.3% with knee tibial refers to the experimental masculine, dysarthria, ataxia gait appear the highest rate, respectively; financial burdens, 91.2% ft percentage, financial burdens MSA - P type patients first signs for sluggish and tremors more of 69.2%, respectively, micturition barrier, 30.8% muscle tone heighten, expression, the highest rate of appear inflexible respectively; the obligatory, 69.2% 92.3%, MSA-A patient urinate more for starting symptoms, 50%, micturition obstacles obstacles abnormal gait, and the emergence of orthostatic hypotension, higher rates are 75%, 62.5%, 50%. Comparison of findings in the subtypea revealed that the anteroposterior and transverse diameter of the middle cerebellar paduncles,the transverse diameter of the pons,the anteroposterior and the transverse diameter of the medulla oblongata in MSA -C were smaller than in MSA-A,and significantly enlargement of the forth ventricke in MSA-C when compared to (p<0.05),the anteroposterior of the diameter putamen, and the anteroposterior diameter of the globus pallidus,the transverse diameter of the dentate nucleus werer smaller in MSA-A than in MSA-C(p<0.05),the anteroposterior of the diameter putamen, and the anteroposterior diameter of the globus pallidus,The transverse diameter of the red nuclei were smaller in MSA-C than in MSA-P(p<0.05),There were no difference between MSA-P and MSA-A.Conclusion: 1. MSA-C, MSA-P, MSA-A are major clinical subtypes of MSA, MSA-C is the most common. 2. MSA-C, MSA -P, MSA-A third type characteristic respectively early performance with knee tibial nasal - refers to the test is positive, dysarthria and ataxia gait; Micturition barriers, sluggish and tremor; Micturition obstacles, orthostatic hypotension. Micturition obstacles and cone bundle of MSA parting meaningless refunding. 3. Atrophy of the cerebellum and brain stem was seen more often in patients with MSA-C. Atrophy of putamen,globus pallidus,red nuclei was seen more often in patients with MSA-P and MSA-A, there was no brain structure volume difference between MSA-P and,MSA-A.
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