Case 34 - Falling before forgetting

Summary

This chapter talks about a 67-year-old man who was admitted to a Movement Disorders Clinic with a history of unstable gait with frequent falls, intermittent blurred vision with diplopia while reading or watching television, personality changes with social withdrawal, lack of initiative, and reduced spontaneous speech. Neurological examination revealed hypomimia with reduced blink frequency, reduced spontaneous speech with monotonous prosody, and bilaterally reduced hearing. The initial clinical diagnosis was based on the patient's history and neurological examination. Symptom debut with gait instability, frequent falls, and incomplete Parkinsonism with postural instability, symmetric bradykinesia without rigidity or tremor, disturbance in ocular motility and early occurrence of subcortical dementia with frontal-dysexecutive problems, and relatively preserved memory made Progressive Supranuclear Palsy (PSP) the most likely diagnosis. The patient had a prototypical Progressive Supranuclear Palsy (PSP), characterized by postural instability and falls within a year of disease onset, as well as reduced vertical eye movements.