Challenges with the differential diagnosis of progressive supranuclear palsy and Parkinson''s disease
Progressive supranuclear palsy (PSP) is a severe oldage neurodegenerative disease that is characterized by pronounced clinical polymorphism and has different phenotypes. Practical differential diagnosis of PSP and Parkinson's disease (PD) presents significant challenge, especially in onset of the disease. We report an atypical case of PSP characterized by symmetric levodoparesistant parkinsonian syndrome, early postural instability, supranuclear oculomotor disorders (vertical gaze palsy), MR signs of midbrain atrophy, and a number of overlapping clinical symptoms similar with the manifestations of PD. A detailed algorithm of differential diagnosis of PSP and PD as well as a more adequate diagnostic formulation are proposed for this and similar cases of neurodegenerative pathology.