Probable progressive supranuclear palsy in a patient with chronic schizophrenia: A case report.

Content Provider	Europe PMC
Author	Kita, Akira Tsuji, Tomikimi Koh, Jinsoo Takahashi, Shun Yamamoto, Masahiro Sakamoto, Yuka Itogawa, Hideaki Kimoto, Sohei
Copyright Year	2020
Abstract	Rare neurodegenerative disorders may be considered in the differential diagnosis of Parkinsonism in patients with schizophrenia who show worsening signs of Parkinsonism under treatment with antipsychotics. To the best of our knowledge, the present study is the first report describing probable progressive supranuclear palsy (PSP) in a patient with chronic schizophrenia. A 64-year-old man presented with hallucinations, delusions and asociality. He had received treatment with both typical and atypical antipsychotics for ~13 years. He began experiencing short-term memory impairment and bradykinesia two years before presentation, and then showed increased dysphagia, upper-limb muscle rigidity, extrapyramidal symptoms, vision loss and photophobia. Psychological manifestations included chronic depression, irritability and, occasionally, euphoria. His gait worsened, leading to repeated falls. Antipsychotics were discontinued, and the patient was almost completely dependent on a wheelchair in daily life. In a neurology consultation, he was diagnosed with probable progressive supranuclear palsy-Richardson's syndrome presenting as vertical supranuclear gaze palsy and prominent postural instability with falls. Brain magnetic resonance imaging (MRI) revealed atrophy of the mesencephalic tegmentum, and 123I-ioflupane single-photon emission computed tomography (SPECT) revealed reduced bilateral striatal reuptake. Overall, PSP should be considered in patients with schizophrenia with worsening Parkinsonism, especially when it is accompanied by supranuclear ophthalmoplegia, pseudobulbar palsy, dysarthria and dystonic stiffness of the neck and upper body. In the present case, the combination of brain MRI and 123I-ioflupane SPECT helped to discriminate PSP from other Parkinsonian syndromes, including drug-induced Parkinsonism, in the differential diagnosis.
ISSN	17920981
Journal	Experimental and Therapeutic Medicine
Volume Number	24
PubMed Central reference number	PMC9214598
Issue Number	1
PubMed reference number	35761809
e-ISSN	17921015
DOI	10.3892/etm.2022.11411
Language	English
Publisher	D.A. Spandidos
Publisher Date	2022-06-01
Access Restriction	Open
Rights License	This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Copyright: © Kita et al.
Subject Keyword	progressive supranuclear palsy-Richardson's syndrome Schizophrenia Parkinsonism magnetic resonance imaging case report
Content Type	Text
Resource Type	Article
Subject	Immunology and Microbiology Cancer Research