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Progressive supranuclear palsy — SCE Neurology MCQ

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ModerateMovement DisordersProgressive supranuclear palsySCE Neurology

A 70-year-old man has repeated backward falls within 12 months of symptom onset. Examination shows axial rigidity, hypophonia and impaired vertical saccades, especially downgaze. Levodopa has produced little benefit. Cognition shows frontal executive dysfunction. What is the most likely diagnosis?

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Correct answer: D — Progressive supranuclear palsy

Progressive supranuclear palsy is the best answer. Early backward falls, vertical gaze impairment, axial rigidity and poor levodopa response strongly indicate PSP. Parkinson's disease usually falls later and responds to levodopa; corticobasal syndrome is asymmetric cortical-motor disease; essential tremor lacks bradykinesia; NPH causes gait apraxia with ventriculomegaly. Clinical pearl: Downgaze limitation is a high-yield sign in atypical parkinsonism.

Reference: Movement Disorder Society PSP criteria; NICE NG71