Hence, the authors share how multiple neurodegenerative movement disorders can coexist in a single patient, specifically, clinically established MSA-C and lower motor neuron disease findings at par with progressive muscular atrophy (PMA), but tested positive for an ERBB4 gene, a heterozygous variant of uncertain significance, associated with the autosomal dominant amyotrophic lateral sclerosis (ALS). The gene discussed is ERBB4; the disease is pilomyxoid astrocytoma.