Abstract : Multiple system atrophy is a rare progressive neurodegenerative disorder also known as synucleinopathies, due to abnormal accumulation of alpha-synuclein protein in several parts of brain including basal ganglia, inferior olivary nucleus and cerebellum. It affects 5 per 1,00,000 people, age of onset is 55-65, incidence more in males than female, ratio (1.3 :1). Multiple system atrophy presents as parkinsonism like symptoms and ataxia. Due to autonomic dysfunction patient may have orthostatic hypotension, loss of sweating, impotence, urinary retention and incontinence. Old classification includes striatonigral degeneration (SND), olivopontocerebellar atrophy (OPCA), and Shy-Drager syndrome. But current classification based on predominant symptoms at time of evaluation of disease. 1) MSA- P, parkinsonian variant in that extra pyramidal features are predominately seen also termed as striato nigral degeneration. 2) MSA- C, cerebellar ataxia is predominant also termed as olivopontocerebellar atrophy.