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Progressive Supranuclear Palsy — SCE Neurology MCQ

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HardMovement DisordersProgressive Supranuclear PalsySCE Neurology

A 55-year-old woman presents with a 1-year history of progressive difficulty walking with frequent falls backwards, vertical supranuclear gaze palsy (particularly downgaze), axial rigidity greater than limb rigidity, and frontal behavioural changes. What is the most likely diagnosis?

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Correct answer: E — Progressive supranuclear palsy – Richardson syndrome

The best answer is “Progressive supranuclear palsy – Richardson syndrome”. Parkinsonian syndromes are distinguished by tempo, symmetry, eye movements, falls, autonomic and cognitive features; treatment is individualised to motor and neuropsychiatric burden. The alternatives “Parkinson's disease, within the relevant UK pathway”, “Multiple system atrophy – cerebellar type”, “Corticobasal degeneration, after specialist assessment”, “Dementia with Lewy bodies” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG71 Parkinson disease recommendations: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations