Presentation
Progressive decreased cognition. Visual, speech and gait impediments.
Patient Data
There is global involutional change. There is particular midbrain atrophy with a mild concave superior margin, a deep interpeduncular cistern and a concave dorsolateral midbrain margin. There is a subtle high signal within the pontine tegmentum on T2 and Flair imaging.
There is minimal non-specific microvascular ischemic change. Giant perivascular space within the right basal ganglia.
There is normal enhancement post contrast administration.
Case Discussion
Neurodegenerative conditions are difficult to diagnose on imaging features alone and in isolation of the clinical presentation. Concordant imaging and clinical findings often allude to a potential diagnosis and are supported by a multidisciplinary assessment and agreement of the diagnosis or probable diagnosis.
In this instance, features are suggestive of progressive supranuclear palsy (PSP) as demonstrated by the hummingbird, Mickey Mouse and morning glory signs. There is a global involutional change that may account for the cognitive decline, however, the clinical combination of the visual, speech and gait disturbances and known chronic atypical Parkinsonism history was confirmed to be compatible with PSP.
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