PSP with Vertical Gaze Palsy, Abnormal Optokinetic Nystagmus and Inability to Suppress Blinking to Light

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 75-year-old woman with a diagnosis of progressive supranuclear palsy (PSP). Examination demonstrated vertical supranuclear gaze palsy (i.e., it could be overcome by the vertical vestibulo-ocular reflex [VOR]), saccadic smooth pursuit and VOR suppression (not shown), and hypometric and slow horizontal saccades, and with an optokinetic flag, there were weak fast phases (saccades) horizontally, and absent fast phases vertically. Slowing of downward saccades and loss of the downward fast phase with an optokinetic flag are commonly early signs in PSP, which tend to precede the development of the downgaze/vertical palsy. Additionally, patients with PSP tend to have difficulty suppressing blinks when a bright light is shone into the eyes - a finding akin to the glabellar reflex, which is often present in neurodegenerative conditions such as Parkinson's disease. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient had a vertical supranuclear gaze palsy (i.e., it could be overcome by the vertical vestibulo- ocular reflex [VOR]), saccadic smooth pursuit and VOR suppression (not shown), and hypometric and slow horizontal saccades, and with an optokinetic flag, there were weak fast phases (saccades) horizontally, and absent fast phases vertically. Slowing of downward saccades and loss of the downward fast phase with an optokinetic flag are commonly early signs in PSP, which tend to precede the development of the downgaze/vertical palsy. Additionally, patients with PSP tend to have difficulty suppressing blinks when a bright light is shone into the eyes - a finding akin to the glabellar reflex, which is often present in neurodegenerative conditions such as Parkinson's disease. https:// collections.lib.utah.edu/ark:/87278/s6810bdv