Challenges with the differential diagnosis of progressive supranuclear palsy and Parkinson’s disease

Abstract

Progressive supranuclear palsy (PSP) is a severe old-age neurodegenerativedisease that is characterized by pronouncedclinical polymorphism and has different phenotypes. Practicaldifferential diagnosis of PSP and Parkinsons disease(PD) presents significant challenge, especially in onset of thedisease. We report an atypical case of PSP characterized bysymmetric levodopa-resistant parkinsonian syndrome, earlypostural instability, supranuclear oculomotor disorders (verticalgaze palsy), MR signs of midbrain atrophy, and a numberof overlapping clinical symptoms similar with the manifestationsof PD. A detailed algorithm of differential diagnosis ofPSP and PD as well as a more adequate diagnostic formulationare proposed for this and similar cases of neurodegenerativepathology.

Keywords

• parkinsonism
• progressive supranuclear palsy
• parkinson’s diseas
• differential diagnosis