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Amaurosis fugax from carotid stenosis — SCE Neurology MCQ

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HardStrokeAmaurosis fugax from carotid stenosisSCE Neurology

A 69-year-old develops recurrent backward falls within a year of parkinsonism, axial rigidity, dysarthria and slowed vertical saccades progressing to supranuclear downgaze palsy. Levodopa gives little benefit. Which diagnosis best fits?

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Correct answer: E — Progressive supranuclear palsy with Richardson syndrome

Early backward falls, axial-predominant akinetic rigidity and vertical supranuclear gaze palsy define the Richardson phenotype of progressive supranuclear palsy. MSA is dominated by autonomic or cerebellar failure, corticobasal syndrome is markedly asymmetric with cortical signs, DLB requires prominent cognitive fluctuations or hallucinations, and idiopathic Parkinson disease rarely causes early vertical gaze palsy and falls.

Reference: Progressive supranuclear palsy: diagnosis and management (Published October 2021): https://pmc.ncbi.nlm.nih.gov/articles/PMC8461411/