| Identifier |
progressive_supranuclear_palsy_Lee |
| Title |
Progressive Supranuclear Palsy |
| Creator |
Andrew G. Lee, MD; Jared Alexander |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JA) Class of 2021, Baylor College of Medicine, Houston, Texas |
| Subject |
Palsy; Supranuclear; Glasses |
| Description |
Summary: ● Progressive supranuclear palsy (PSP) ○ Progressive disorder of the elderly ○ Supranuclear → doll's head maneuver overcomes the ophthalmoplegia ○ Bilateral, symmetric ● Down-gaze palsy is the key feature of PSP ○ Elderly patients - it often becomes more difficult to look up as we age, which is progressive and normal ○ Suspect PSP if you see down-gaze palsy in a patient with Parkinson's Disease/Parkinsonism/Medication-refractory Parkinson's ● Patients with PSP have similar features to patients with Parkinson's Disease ○ Decreased blinking, masked facies ● Passive head movement overcomes palsy ○ This means the palsy is not: myasthenic, neurogenic (cranial nerve palsy), infranuclear (muscle or nerve) ● Glasses for PSP ○ Single vision glasses because they cannot use bifocals ○ Want to eliminate their need to look down by bringing their world up ○ No cure for PSP, only treatments that are not very effective ● Summary: ○ Down-gaze palsy is not seen in Parkinson's ○ Confirm PSP in patient with down-gaze palsy by using the doll's head maneuver ○ Only give single vision glasses ○ Bring their world up |
| Transcript |
So, we're going to be talking about Progressive supranuclear palsy, also known as PSP. As the name implies it is a progressive disorder of the elderly. It's supranuclear, and what that means is we can overcome the ophthalmoplegia with the doll's head maneuver. And it's a palsy that's usually bilateral and symmetric. And the key and differentiating feature is the down-gaze palsy. So, as you know, elderly patients often have difficulty looking up and it becomes progressively, slowly worse. You should not use the up-gaze palsy to determine PSP because that up-gaze palsy can be just normal in older people. But in down-gaze palsy, if you ever see this, especially in someone who has either Parkinson's disease or parkinsonism or Parkinson's that's not responding to medical therapy, those are the big red-flags that it might not be Parkinson's Disease and it might be PSP instead. And in patients with PSP they're going to have similar features to the Parkinson's patients. They're going to have decreased blinking and they're going to have masked facies, and that's why it's often confused with Parkinson's disease because it has similar features in terms of the neurodegenerative component. The main thing about PSP is the down-gaze palsy can be overcome with the doll's head maneuver. So just by moving the head passively we can get the eyes to move down which means it's not myasthenia, it's not neurogenic from a cranial nerve palsy, it's not infranuclear in terms of muscle or nerve. It is a supranuclear palsy if we can overcome with the doll's head. So, for Ophthalmologists the main thing not to give down-gaze palsy patients, but especially patients with a PSP, is we want to have single vision readers, which are glasses just for near or just for distance because they can't use the bifocal. We want to bring all their world up either with a little table for eating or reading materials so that they don't have to look down. So, by eliminating the need to look down you can really help people with PSP because PSP doesn't have any cure. So even though there are treatments there are no good treatments for PSP. So, the main thing is recognizing that a down-gaze palsy is not seen in Parkinson's disease. If you see this down-gaze palsy we're going to try and confirm if it's supranuclear by using the doll's head maneuver. Once you've made the diagnosis of PSP, we're going to communicate that information to Neurology. And please don't give them bifocals or trifocals or progressives. They need to have single vision glasses. And bring their world up so they don't have to look down. |
| Date |
2019-10 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s66f0jh6 |
| Setname |
ehsl_novel_lee |
| ID |
1469321 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s66f0jh6 |
