A Diagnostic Odyssey: Progressive Supranuclear Palsy Presenting with Gait Disturbance, Behavioral Changes, and Femoral Fracture in a Low-Resource Setting

Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disorder that presents with a spectrum of motor, behavioral, and cognitive features. Its clinical overlap with Parkinson’s disease and other parkinsonian syndromes often leads to misdiagnosis. In low-resource settings, diagnostic challenges are compounded by limited access to neuroimaging, specialist care, and awareness of atypical parkinsonian disorders. Case presentation: We report a 69-year-old Nigerian male with a 10-month history of progressive gait disturbance, behavioral changes, and recurrent falls. Initial misdiagnoses and reliance on traditional remedies delayed appropriate care. Neurological examination revealed axial rigidity, retrocollis, and supranuclear vertical gaze palsy. Magnetic resonance imaging (MRI) demonstrated midbrain atrophy with preserved pontine volume, the characteristic “hummingbird sign,” a radiological hallmark of PSP. A concurrent left femoral head fracture, a rare musculoskeletal complication of PSP, was identified, likely secondary to repeated falls and immobility. Conclusion: This case emphasizes the diagnostic complexity of PSP in resource-limited environments and highlights the importance of clinical vigilance, early neuroimaging, and multidisciplinary management. It also underscores the need for proactive fall-prevention strategies to reduce secondary complications. Greater awareness among clinicians and integration of imaging findings into routine practice may improve recognition and outcomes in similar settings.