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Washington University Experience | NEURODEGENERATION | Progressive Supranuclear Palsy (PSP) | 13A0 Case 13 History
Case 13 History ---- The decedent was a 92yo female with a history of suspected progressive supranuclear palsy, hypothyroidism, hypertension, hyperlipidemia, and hysterectomy. In January 2014 she complained of progressive dysarthria and dysphagia over the course of 3-4 years. She had also noted generalized weakness, fatigue and bradykinesia and she suffered falls for 2 years prior to presentation. There was no subjective memory loss or other cognitive symptoms and she was living independently at home and driving to work. On physical exam she was found to have a marked supranuclear gaze palsy with complete loss of downward gaze. Magnetic resonance imaging of the brain demonstrated temporal and parietal volume loss without significant midbrain atrophy. Laboratory findings showed a low titer of anti-acetylcholine receptor antibodies and a markedly elevated anti-striated muscle antibody. Computed tomography (CT) of the chest was ordered to evaluate for a thymoma and was negative. At subsequent follow up visits, further progression of dysarthria was noted. There was no relief from carbidopa/levodopa. She also continued to have falls, although she was still able to perform many activities of daily living herself. In the weeks before her death, she was enrolled in at home hospice and expired in 2/2015.
