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Multiple System Atrophy – Cerebellar Type — SCE Neurology MCQ

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HardMovement DisordersMultiple System Atrophy – Cerebellar TypeSCE Neurology

A 69-year-old has early backward falls, axial rigidity and dysarthria. Vertical eye movements are full range, but commanded downward saccades are slow and take a curved lateral trajectory before reaching the target. Which interpretation is most appropriate?

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Correct answer: A — This “round-the-houses” saccade is an early ocular motor clue to progressive supranuclear palsy

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

A delays recognition because PSP may initially preserve range. B does not produce this characteristic curved slow vertical saccade. C causes adduction weakness with abducting nystagmus. D describes a different mechanism in which repeated attempts can elicit a fast full saccade. E is correct: slow vertical saccades and the curved downward “round-the-houses” trajectory may precede fixed supranuclear gaze restriction in PSP.

Reference: Progressive supranuclear palsy: diagnosis and management: https://pn.bmj.com/content/21/5/376