Atypical presentation of progressive supranuclear palsy

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Abstract
Four pathologically documented cases of profressice supranuclear palsy are reported. Two patients exhinited severe dementia and 2 parkinsonism; none had the classic opthalmoplegia. On retrospective analysis, clues to the diagnosis included early prominent gait disturbance, apraxia of eyelid opening in 1 patient, lack of tremor, poor response to levodopa‐carbidopa, and severe rigidity with a posture of neck extension terminally in 1 patient. The clinical presentation of progressive supranuclear palsy, therefore, is not as stereotyped as previously thought, and the diagnosis can be overlooked if one adheres rigidly to the classic diagnostic criteria.

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