Frequent and Unexplained Falls: A Case of Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is the most common neurodegenerative form of atypical parkinsonism. Although its prevalence has increased recently, it remains underdiagnosed. PSP is characterized by parkinsonism, downward gaze disorder, and a tendency to fall due to degeneration of the basal ganglia, brain stem, and cerebellum. Various clinical presentations have been linked to this entity, often making its diagnosis difficult, which can take three to four years to be established. PSP diagnosis mainly relies on clinical data and can only be confirmed with the neuropathological findings at autopsy. However, as per recent research, neuroimaging, namely brain MRI, can aid in an earlier diagnosis. We report the case of an 85-year-old female with a history of recurrent and unexplained falls over the last two years that had been wrongly attributed to Parkinson's disease (PD). She initially presented complaining of recurring falls associated with retropulsion movements that got progressively worse and eventually was not able to walk on her own. Concomitantly, there was also a cognitive dysfunction with frontal predominance. An exhaustive physical examination and clinical history revealed indicators consistent with PSP. PSP diagnosis demands a high clinical suspicion, and hence clinicians should have a good understanding of this disease for its early recognition. Although it is a devastating disorder, and no medications that can reverse the disease course are currently available, early diagnosis of PSP may contribute to improving the quality of life of the patients and their families, and prevent complications. This report highlights the clinically significant improvement in motor and neuropsychiatric symptoms when a multidisciplinary medical team is involved in the care of a PSP patient.