Distinctive features between progressive supranuclear palsy and Parkinsons Disease

Distinctive features between progressive supranuclear palsy and Parkinsons Disease

How can progressive supranuclear palsy be distinguished from Parkinsons Disease? 

The most distinctive feature of progressive supranuclear palsy is the supranuclear downgaze palsy, which is not found in Parkinsons Disease, the most common misdiagnosis of progressive supranuclear palsy.

The differentiation is particularly difficult when the characteristic supranuclear ophthalmoparesis is not evident, as may be the case in early stages of progressive supranuclear palsy.

Some patients who never develop this finding are found at autopsy to have progressive supranuclear palsy.

The difficulty in establishing the diagnosis of progressive supranuclear palsy is suggested by an average delay in making the diagnosis of 3.6 years after onset of symptoms.

The measurement of midbrain atrophy ratio on MRI as well as the use of computerized posturography to analyze gait and posture are useful tools in reliably differentiating early progressive supranuclear palsy from Parkinsons Disease and age-matched controls.

Differential Diagnosis of Progressive Supranuclear Palsy and Parkinsons Disease

Clinical FeaturesPSPPD
Age at onset (decade)7th6th
Initial symptomsPostural and gait disorderTremor and bradykinesia
Family history±
Multi-infarct state±
Dementia± (visual/motor)±
Downgaze ophthalmoparesis+
Eyelid abnormalities+±
Pseudobulbar palsy+±
GaitWide, stiff, unsteadySlow, shuffling, narrow, festinating
RigidityAxial (neck)Generalized
Facial expressionAstonished, worriedHypomimia
Tremor at rest+
Dystonia+±
Corticobulbospinal signs±
Symmetry of findings+
Weight loss+
Improvement with dopamine drugs+
Levodopa-induced dyskinesias+

 +, Yes or present; –, no or absent; ±, may be present or absent; PSP , progressive supranuclear palsy; PD , Parkinson’s disease.

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