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Washington University Experience | NEURODEGENERATION | Progressive Supranuclear Palsy (PSP) | 2A0 Case 2 History
Case 2 History ---- This patient was a 76yo female who presented to the Movement Disorders Center (MDC) in September 2005. She was in good health until 2002 (age 73 years). At that time, her family noticed some cognitive changes. She stopped cooking and her short-term memory was impaired; she also had postural imbalance with many falls. Within the last 1-2 years she began to whisper. She became dysphagic and had problems with eye movements and had to move her head to look up or down. A presumptive clinical diagnosis of PSP was made. Head trauma was cited as a possible etiological event; there was a history of multiple fractures caused by falls. The neurologic exam showed the patient was only orientated to person. Attention, language, and judgement were surprisingly normal. She was moderately hypophonic. Affect was blunted. There were no hallucinations, delusions, suicidal thoughts, obsessions or compulsions. The right pupil did not react to accommodation. Extraocular movements were abnormal. There were limited saccades in all directions but verticality was most impaired. She had very poor pursuit horizontally and could not pursue vertically. Convergence was abnormal. There was no nystagmus. There was ptosis of the right eye. Resting and postural tremors were present. There was severe disturbance of gait which required assistance and she was unable to stand without assistance. There was hyperreflexia bilaterally. In summary, this patient has probable PSP: severe, rapidly progressive parkinsonism stage 4 with mildly asymmetric rigidity with axial predominance, bradykinesia, severe postural instability, early dysphagia, dementia, and supranuclear gaze palsy. These features are most consistent with PSP although the asymmetry may be seen in corticobasal degeneration. The reported cause of death was bronchopneumonia
