Progressive supranuclear palsy

Alternative names:

dementia-nuchal dystonia; palsy - progressive supranuclear; Richardson-Steele-Olszewski syndrome

Symptoms:

• repeated falls
• loss of coordination, unsteady gait (walking pattern)
• stiffness and rigid movement in the neck, trunk, arms, legs
• pain or difficulty with bending the neck up or down
• slow or stiff movements
• vision difficulty
  • unable to look up or down without bending the neck

• changes in facial expression
  • "masking", reduced expression
  • deeply lined face
  • jaw or face jerks or spasms
  • eyes, pupils different size
  • eye movements, uncontrollable

• generalized slowness of all movement (bradykinesia) with strength relatively preserved
• speech difficulties
  • slow speech
  • poor enunciation
  • low voice volume

• dementia, mild
  • forgetfulness
  • slowed thought processes
  • apathy (indifference)
  • difficulty manipulating knowledge

• personality changes, vague and mild

Signs and tests:

Neuromuscular examination may show Parkinsonian movements with typical stiffness and lack of coordination. Dementia is mild. Eye movements are limited, particularly vertical movements; however, vision, hearing, sensation, and voluntary control of movement remains intact.