Background: The spinocerebellar ataxias (SCA) are a group of multiple inherited disorders. The molecular diagnosis of the specific type of SCA is challenging due to the diversity of hereditary patterns and genetic anomalies. Certain key clinical features can help shorten the differential diagnosis. Cases: At our center, we evaluated three patients presenting with gait disturbances. They were assessed by multiple hospital departments, and, due to suspected spinocerebellar ataxia, comprehensive genetic and ophthalmologic testing was performed, leading to diagnoses of SCA2, SCA7, and SCAR32. These cases highlight the importance of multidisciplinary evaluation for accurate diagnosis of complex neurogenetic disorders. All patients experienced prolonged diagnostic delays, requiring years of multiple consultations across different hospitals before reaching a definitive diagnosis. Literature Review: Among all published reports of patients with SCA, we consider that five distinct key clinical features can categorize many patients suffering from a possible SCA into different groups and reduce the potential differential diagnosis. Only two types of SCA presented macular anomalies, ten optic nerve involvements, one erythrokeratodermia, four hearing losses, and four dementias. Conclusions: Early referral to a multidisciplinary evaluation might help narrow the differential diagnosis of specific types of SCA, guiding the diagnostic work-up toward SCA1 and SCA7 in patients with macular involvement, or toward SCA1, SCA2, SCA3, SCA7, SCAR3, SCAR9, SCAR21, SCAR29, SCAR31, and SCAX3 in those with optic nerve involvement.