A 72-year-old man presents with progressive gait difficulty, rigidity, and bradykinesia over 2 years. He has frequent falls, predominantly backward. On examination, he has a wide-based gait, axial rigidity greater than limb rigidity, and inability to generate voluntary vertical saccadic eye movements, especially downward gaze. His tremor is minimal. Which atypical parkinsonian syndrome is most likely?

• A Multiple system atrophy (MSA)
• B Dementia with Lewy bodies (DLB)
• C Corticobasal degeneration (CBD)
• D Progressive supranuclear palsy (PSP) ✓

Explanation

Progressive supranuclear palsy (PSP) is characterized by early postural instability with backward falls, axial rigidity greater than limb rigidity, vertical gaze palsy (especially downgaze), and poor levodopa response. The vertical supranuclear gaze palsy is the hallmark that distinguishes PSP from Parkinson's disease. MSA presents with autonomic failure plus parkinsonism (MSA-P) or cerebellar ataxia (MSA-C). CBD presents with asymmetric apraxia and alien limb. DLB presents with dementia preceding or concurrent with parkinsonism and visual hallucinations.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.