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Progressive Supranuclear Palsy — RACP Adult Medicine MCQ

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ModerateNeurologyProgressive Supranuclear PalsyRACP Adult Medicine

A 65-year-old man presents with falls, early postural instability, vertical supranuclear gaze palsy (particularly downgaze), and axial rigidity greater than limb rigidity. He has a surprised facial expression. Response to levodopa is poor. What is the most likely diagnosis?

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Correct answer: D — Progressive supranuclear palsy

Early falls with postural instability, vertical supranuclear gaze palsy (especially downgaze), axial rigidity, surprised facies, and poor levodopa response are hallmarks of progressive supranuclear palsy (Richardson syndrome). The hummingbird sign on MRI (midbrain atrophy) is a supportive imaging feature.

Reference: MDS – 2024 – PSP Diagnostic Criteria