Abstract： Objective:To investigate the characteristics of videonystagmography (VNG) in multiple system atrophy (MSA) patients with vertigo as the main symptom.Methods:Twenty-eight MSA patients and 28 healthy volunteers were selected, and their basic clinical data, namely, gender, age of onset, course of disease, initial symptoms, and clinical manifestations, were collected. VNG was adopted to measure spontaneous nystagmus and carry out gaze test, saccade test, smooth tracking test, visual movement test, position test, and temperature test.Results:Among the MSA patients with vertigo as the main symptom, the number of MSA-C (the cerebellar type) cases ( n=22) was significantly higher than that of MSA-P (the parkinsonian type) cases ( n=6), and there was no statistically significant difference in gender, age of onset, and course of disease ( P>0.05). The incidence of gaze nystagmus was 45.5% (10/22) in the MSA-C group and 33.3% (2/6) in the MSA-P group, which were significantly higher than that in the control group ( P<0.05). The abnormal rate of saccade test was which were significantly higher than that in the control group ( P<0.05). The abnormal rate of saccade test was 36.4% (8/22) in the MSA-C group, and no abnormality was found in the MSA-P group and the control group. The rate of abnormal visual tracking was 77.3% (17/22) in the MSA-C group and 83.3% (5/6) in the MSA-P group, which were significantly higher than that of the control group ( P<0.05). The rate of decreased optokinetic nystagmus (OKN) or nystagmus asymmetry was 40.9% (9/22) in the MSA-C group and 83.3% (5/6) in the MSA-P group, which were significantly higher than that of the control group ( P<0.05). The abnormal rate of position test was 22.7% (5/22) in the MSA-C group and 33.3% (2/6) in the MSA-P group, which showed no statistically significant difference when compared with that of the control group ( P>0.05). In the temperature test, the abnormal rate of unilateral weakening was 22.7% (5/22) in the MSA-C group, which was significantly higher than those in the MSA-P group and the control group. The hyperresponsiveness rate of cold and heat stimulation was 4.5% (1/22) in the MSA-C group, while there was no hyperresponsiveness in both the MSA-P group and the control group. The failure rate of fixation inhibition was 63.6% (14/22) in the MSA-C group, and there was no failure in the control group. Conclusion:In MSA patients with vertigo as the main symptom, the incidence of abnormal eye movements, especially the symptoms of visual tracking abnormality, fixation inhibition failure, and gaze nystagmus, is relatively high. The results of this analysis can help clinical diagnoses.