A 70-year-old man has repeated unexplained falls in the first year of his illness, a staring facial expression, and inability to look down voluntarily, though his eyes move fully on doll's head manoeuvre. He also has slowed cognition and axial rigidity without tremor. What is the underlying pathology?
- A Alpha-synuclein accumulation in Lewy bodies
- B Amyloid beta plaques and neurofibrillary tangles
- C Tau accumulation with neuronal loss in the substantia nigra and globus pallidus ✓
- D TAR DNA-binding protein 43 inclusions in motor neurons
Correct answer: C. Tau accumulation with neuronal loss in the substantia nigra and globus pallidus
Explanation
Supranuclear vertical gaze palsy with early postural instability and falls within the first year, axial rigidity, and subcortical dementia define progressive supranuclear palsy, a tauopathy with globose neurofibrillary tangles in the substantia nigra, globus pallidus, and brainstem. The full range of passive eye movement on oculocephalic testing confirms the palsy is supranuclear. Alpha-synuclein pathology points to Parkinson or Lewy body disease instead.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.