Multiple system atrophy (MSA) is characterized clinically by the combination of Parkinsonian, pyramidal, cerebellar, and autonomic symptoms. If parkinsonism predominates in the clinical picture of the disease, the condition is named striatonigral degeneration or MSA type P (P stands for parkinsonism). A 67 years’ old woman with a previous clinical diagnosis of striatonigral degeneration and a five year history of the symptoms had initially been misdiagnosed as suffering from Parkinson’s disease. However, she did not respond well to levodopa and soon developed severe dysarthria. The neurological features, helpful in differentiating MSA type P from other extrapiramidal disorders, included falling, dysarthria and dysphonia, respiratory stridor, hyperreflexia and ataxia. Cerebellar signs were well manifested, whereas autonomic symptoms were less severe. Besides neurological and imaging study, a specially designed Speech Efficiency Test for dysarthria was performed. It revealed numerous speech deficiencies: a flat Fo contour, slow speech pace and a tendency to divide words into syllables. Vowels were centralized and reduced, obstruents articulated with impeded precision, and nasals produced with irregular soft palate timing. Glottal activity was characterized by lowered Fo and breathy phonation.