A 60 year old man was brought in by his wife complaining of ataxia, urinary incontinence and erectile dysfunction. He also complains of rigidity and slowing of movement with a pill rolling tremor of the hands. What is the likely diagnosis?

The key is C. Shy-drager syndrome. [Shy-drager syndrome is characterized by parkinsonism (rigidity,

slowing of movement with hand tremors) plus a more pronounced failure of the autonomic nervous

system (urinary incontinence and erectile dysfunction) and there may also cerebellar sign like ataxia be

present]. [Please note the discrepancy of this question (may be a bad recall) that classic pill rolling

movement is not a feature of multiple system atrophy (shy-drager dsyndrome)].