Progressive Supranuclear Palsy

64yr male with the main complain of instability for three years; when he stands up something push him backwards and he has a feeling like walking on sponge.
About a year ago he has started to miss lines while reading and has a problem with sight when bending or looking upwards.
He has diabetes and peripheral neuropathy and depression.

On exam pronounced gaze palsy in vertical plane, saccadic pursuit in horizontal plane and slightly reduced VOR gain to the left.

vng-saccade-vertical vng-tracking-vertical

VHIT in PSP

PSP Hummingbird sign PSP MickeyMouse sign

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