Multiple Systems Atrophy (MSA) is a neurologic disorder clinically characterized by parkinsonism, cerebellar ataxia, and autonomic failure. This disorder was previously known as “striatonigral degeneration sporadic olivopontocerebellar atrophy and “Shy-Drager syndrome Presence of neurogenic bladder is a characteristic feature of MSA. It is regarded as a sporadic disease with a prevalence of 4 per 1,00,000. Typically the symptoms begin between 40 and 60 years of age. It has two phenotypes: parkinsonian (MSA-P) and cerebellar (MSA-C). MRI brain acts as a diagnostic tool for MSA with the characteristic feature of “Hot cross bun' sign, seen as cruciform hyperintensity at the level of the pons in axial T2-weighted images in patients with MSA-C. We report here a case of a 55-year-old female patient who presented with complaint of gait instability, intention tremor, and orthostatic dizziness for the last 1 year. She also developed urinary incontinence from last 4 months