(18F)-FDG pet imaging and Neuro-ophthalmological findings in diagnosis of progressive Supranuclear palsy: Case report

Introduction : Progressive supranuclear palsy is a neurodegenerative disorder, described as a tauopathy. The neuroimaging and visual symptoms are among the most important in the diagnosis of this disease. The ophthalmoparesis mainly concerns voluntary eye movements. Patients mostly present with vertical palsy, involuntary eye movements, convergence insufficiency, and diplopia. Case report : A 62-year-old female patient was admitted to the hospital because of the gait disturbance and frequent falls. She had impaired memory, handwriting and speech for one year. On neurological and neuro-ophthalmological examinations, the patient presented with vertical gaze palsy, involuntary eye movements, dysarthria, tremor in the right hand, and cerebellar ataxia. Blood tests were normal. (18F)-FDG PET revealed bilateral zones of moderate hipometabolism in the regions of posterior frontal cortex, anterior cingulum, left thalamus, head of left striatum, and left temporal lobe. Neuropsychological tests revealed cognitive impairment (MMSE-26; IADL-1). Conclusion : Based on the literature review and our own notices, we suggest that (18F)-FDG PET scanning and neuro-ophthalmological examination in addition to structural neuroimaging and clinical findings play a crucial role in the differential diagnosis of PSP and other parkinsonian syndromes.