A 65-year-old man presents with frequent falls over the past year. His family notes he has difficulty looking down at his food while eating. He also has axial rigidity and mild cognitive slowing. On exam, he cannot voluntarily look downward, though his eyes move normally when his head is passively tilted. What is the most likely diagnosis?
- A Progressive supranuclear palsy ✓
- B Corticobasal degeneration
- C Multiple system atrophy
- D Parkinson's disease
Correct answer: A. Progressive supranuclear palsy
Explanation
Progressive supranuclear palsy classically presents with early postural instability, falls, axial rigidity, and vertical supranuclear gaze palsy. The key finding is impaired voluntary downward gaze with a preserved oculocephalic reflex. Corticobasal degeneration features asymmetric rigidity and alien limb phenomenon. Multiple system atrophy involves prominent autonomic failure. Parkinson's disease lacks early falls and vertical gaze palsy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.