Diagnosis is difficult and typically done by ruling out Parkinsons Disease (PD) or Spinocerebellar ataxia (SCA). Symptoms include autonomic dysfunctions (supine hypertension and orthostatic hypotension, urinary incontinence). The disease leads to selective neuronal loss, myelin pallor, possible microglial activation and usually involves caudate, putamen, substantia nigra and cerebellum. Neuroimaging does show marked features in the putamen and 'hot cross bun' sign in the pons but these are not specific only to MSA. There are two broad groups MSA-P with more PD like features of bradykinesia and resting tremor and MSA-C with more limb/gait ataxia features. Treatment is symptomatic and definitive diagnosis is possible only post mortem (seen by high density oligodendroglial cytoplasmic inclusions).