We report a case of multiple system atrophy-autonomic failure in which the most interesting features were the uncommon onset of a laryngeal stridor in the absence of orthostatic hypotension and the clinical-nosographic possibilities for the autonomic changes found. The differentiation between autonomic failure and pure autonomic failure and their relationship to multiple system atrophy are still under discussion. We agree with the authors who consider that the absence/presence of orthostatic hypotension may be taken as discriminant for this purpose.