What is the difference between Shy-Drager and Pure Autonomic Failure?
The Shy-Drager syndrome is now known as multiple system atrophy (MSA). Pure autonomic failure used to be known as progressive autonomic failure or idiopathic orthostatic hypotension or the Bradbury Eggleston syndrome. Both conditions cause orthostatic hypotension. The biggest differences between MSA and PAF are that the former is associated with involvement of the brain and spinal cord (causing parkinsonism, or cerebellar problems) whereas the latter affects the peripheral nerve. The MSA patient most commonly has difficulty with walking, speaking, moving and writing, whereas PAF is normal except for involvement of the autonomic nervous system. The MSA patient may also have difficulty with breathing and may have sleep apnea. The outlook with PAF is very good once orthostatic hypotension is controlled. The bladder can be involved in both conditions. Dr Phillip A. Low , M.D.
