Neuroophthalmic abnormalities in supranuclear palsy

Abstract

Background: Progressive supranuclear palsy (PSP) is the most common atypical parkinsonism with various movement disorders and oculomotoric abnormalities. Purpose: To identify major neuroophthalmic manifestations in different clinical phenotypes of PSP. Material and Methods: The study was conducted at the Odesa regional clinical hospital in 2011 to 2021. Twenty one patients with PSP (including one patient with PSP combined with Hallervorden– Spatz disease and levodopa-induced hyperkynesis) underwent an examination. This included a classical neurological examination and comprehensive neuroophthalmic examination with high-field magnetic resonance imaging (MRI) of the brain and spine and videonystagmography testing. Mean patient age was 53.2 ± 1.1 years, and most patients were women (13 [61.9%]). Statistical analysis included frequency analysis. Results: PSP-P was the most common phenotype of PSP (52.4%), followed by PSP-PGF (9.5%), PSP-OM (9.5%), PSP-PI (9.5%), PSP-CBS (4.8%), PSP-SL (4.8%), PSP-F (4.8%) and PSP+GSD (4.8%). All patients showed changes in velocity and amplitude of vertical saccades. Diplopia was, however, observed in only 12 (57.1%) patients. Conclusion: Neurological and neuroophthalmic examination is decisive in establishing the diagnosis of progressive supranuclear palsy and selecting a treatment strategy. In the current study, PSP-P was the most common (52.4%) phenotype, the frequency of PSPOM variant was 9.5%.