Progressive supranuclear palsy
Progressive degenerative changes in the basal ganglia, basal nuclei and
It is an uncommon condition, however it is the commonest form of Parkinsonism
plus. It affects patients in their middle age / older
Parkinson ? like rigidity, no tremor
Loss of postural reflexes
Postural dystonia increased on extension
of the head.
Progressive external ophthalmoplegia 1st
to voluntary conjugate vertical gaze then to lateral gaze is diagnostic.
Full range oculo-cephalic reflexes are
deranged on arousal.
Some degree of dementia.
Dopamine agonists (bromocryptine) brings some relief but progress is
invariable. The poor response to treatment is explained by the loss of D2