Calculate Case Studies — Diagnosis of Progressive Supranuclear Palsy (PSP)

With the help of QxMD contributor Dr. Caroline Just we recently released a Progressive Supranuclear Palsy (PSP) diagnosis tool on Calculate by QxMD (https://qxmd.com/calculate/calculator_567). We’re really excited about the tool and wanted to understand how it works in action. So we asked Dr. Just for a case study …

Sergio is a 55-year-old man who presents with a 2-year history of falls and confusion. He has been seen by his family doctor, as well as another neurologist, but does not yet have a diagnosis. His family is very concerned because they worry he has ‘mad-cow Disease’

He is otherwise quite healthy with no family history of neurological disease. His confusion, which is described as trouble with planning and finances, has become progressively worse.

He is having 4–5 falls per week, unprovoked. He has had a few episodes of trouble swallowing liquids. He had an MRI, which shows some generalized atrophy and severe atrophy in the midbrain.

Representative image: T1-weighted Sagittal MRI showing midbrain atrophy leading to the hummingbird sign. Saeed U, Compagnone J, Aviv RI, et al. Imaging biomarkers in Parkinson’s disease and parkinsonian syndromes: current and emerging concepts. Transl Neurodegener 2017;6:8. doi:10.1186/s40035–017–0076–6

He had a lumbar puncture, which was negative for 14–3–3 protein and RT Quik. On exam, he had slow velocity of saccades. You note a hypophonic, spastic dysarthria. On pull-test, he fell backwards. He has parkinsonism, with akinesia and rigidity. He has tried levodopa, with minimal effect.

You use the PSP criteria to diagnose him.