Frequent falls and gaze palsy in two patients

Summary We report two patients who presented with fre­ quent falls, gaze palsy and other clinical features of Progressive Supranuclear Palsy and wish to highlight the importance of distinguishin g this condition from idiopathic Parkinson's disease. ing; and walked with an extended neck with reduced movements of her arms. She found it difficult in going down stairs as looking down was impaired, was be­ coming more forgetful and emotional labile. She had a 'quizzical or astonished' facial appearance, an upward gaze palsy, fragmentation of horizontal pursuit move­ ments and axial rigidity. The mini-mental score was 24/30, with mainly recall deficits. There was no tremor, autonomic disturbances or cerebellar signs. All ten­ don reflexes and the jaw jerk were exaggerated. Rou­ tine biochemical and haematological investigations were normal. An MRI scan of her brain showed atro­ phic changes in the brain stem.