Coat hanger sign of orthostatic hypotension and other MSA pearls/ signs

1.  Patients complain of characteristic muscular pain across neck or shoulder of coat hangar, when standing. 

2.  Squeaky voice distinct from PD (needs oiling)

3.  Erectile dysfunction is present in nearly all men with MSA

4.  Check BP anyway can't rely on typical OH symptoms

5.  Inspiratory  stridor due to vocal cord paralysis or dystonia, may have OSA as well

6.  Cold dusky mottled hands

7.  Anterocollis think MSA, retrocollis think PSP

8.  Applause sign-- ask patients to clap quickly three times, if they continue that is frontal (PSP, PS not PD)

9.  Other frontal signs-- concrete proverbs highly characteristic of PSP, decreased verbal fluency

10. Palilalia / echolalia (seen in PSP) (equivalent of applause sign)

11. Absent vertical opthalmopledia, see slow vertical limited saccades occur first-- compare speed of horizontal and vertical saccades, and no fast phase nystagmus on OKN on vertical.  Beware, pursuit may be OK so must  test saccades.

12.  Unilateral apraxia (note COMPLAINS of apraxia)

13.  Unilateral jerky dystonia = CBD.  (Only other movement disorder that starts unilaterally is PD)

7.