[P1-382]: MULTI-CLASS DIFFERENTIAL DIAGNOSIS AMONG ALZHEIMER's, PARKINSON's, CORTICOBASAL SYNDROME AND PROGRESSIVE SUPRANUCLEAR PALSY

Background: Previous studies reported skin phosphorylated α-synuclein (p-syn) deposits in Parkinson’s disease (PD) patients but not in patients with parkinsonism due to tauopathies, although data on the latter are limited. Objective: We aimed to assess the presence of skin p-syn deposits in patients with clinical diagnosis of parkinsonism usually due to tauopathy and PD. Methods: We consecutively recruited 26 patients, 18 fulfilling clinical diagnostic criteria of progressive supranuclear palsy (PSP) and 8 of corticobasal syndrome (CBS), 26 patients with PD, and 26 healthy controls (HC). All subjects underwent skin biopsy to study p-syn deposits in skin nerves by immunofluorescence. Results: Skin p-syn deposits were present in only two of the PSP/CBS patients and none of the HC. Conversely, all PD patients showed p-syn deposition (p < 0.001, Chi-square). The two p-syn positive patients were diagnosed with PSP and CBS, respectively. Although clinical and MRI findings supported these diagnoses, both patients had some atypical features more typical of synucleinopathies. Conclusion: The detection of skin p-syn deposits may help in the differential diagnosis of parkinsonism. Indeed, in this study, all PD patients and only two out of 26 with a clinical diagnosis of PSP/CBS had skin p-syn deposits. Furthermore, these two patients showed clinical features that could suggest an atypical synucleinopathy presentation or a mixed pathology.

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Parkinsonism and Related Dementias

10.1093/med/9780197512166.003.0079 ◽

2021 ◽

pp. 680-688

Author(s):

Rodolfo Savica ◽

Pierpaolo Turcano ◽

Bradley F. Boeve

Keyword(s):

Differential Diagnosis ◽

Parkinson Disease ◽

Progressive Supranuclear Palsy ◽

Frontotemporal Dementia ◽

Lewy Body ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Corticobasal Degeneration ◽

Corticobasal Syndrome ◽

Progressive Course

The differential diagnosis for dementia is wide. A slowly progressive course for parkinsonism suggests a degenerative cause and helps to narrow the differential diagnosis considerably. In patients with dementia in combination with parkinsonism (often collectively termed the parkinsonism-related dementias), the 4 most common neurodegenerative entities are 1) Lewy body dementias (which include dementia with Lewy bodies and Parkinson disease with dementia); 2) corticobasal syndrome or corticobasal degeneration; 3) Richardson syndrome or progressive supranuclear palsy; and 4) frontotemporal dementia with parkinsonism.

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Characteristics of progressive supranuclear palsy presenting with corticobasal syndrome: a cortical variant

Neuropathology and Applied Neurobiology ◽

10.1111/nan.12037 ◽

2014 ◽

Vol 40 (2) ◽

pp. 149-163 ◽

Cited By ~ 41

Author(s):

H. Ling ◽

R. Silva ◽

L. A. Massey ◽

R. Courtney ◽

G. Hondhamuni ◽

...

Keyword(s):

Progressive Supranuclear Palsy ◽

Corticobasal Syndrome

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11 Differential diagnosis: Progressive supranuclear palsy vs postencephalitic parkinsonism

Neurobiology of Aging ◽

10.1016/s0197-4580(96)80013-3 ◽

1996 ◽

Vol 17 (4) ◽

pp. S3

Author(s):

K.A. Jellinger

Keyword(s):

Differential Diagnosis ◽

Progressive Supranuclear Palsy ◽

Postencephalitic Parkinsonism

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VEGF Haplotypes are Associated with Increased Risk to Progressive Supranuclear Palsy and Corticobasal Syndrome

Journal of Alzheimer s Disease ◽

10.3233/jad-2010-091615 ◽

2010 ◽

Vol 21 (1) ◽

pp. 87-94 ◽

Cited By ~ 8

Author(s):

Barbara Borroni ◽

Roberto Del Bo ◽

Stefano Goldwurm ◽

Silvana Archetti ◽

Cristian Bonvicini ◽

...

Keyword(s):

Progressive Supranuclear Palsy ◽

Corticobasal Syndrome ◽

Increased Risk

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Supranuclear Ophthalmoplegia

Neuro-Ophthalmology ◽

10.1093/med/9780190603953.003.0025 ◽

2019 ◽

pp. 137-140

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak

Keyword(s):

Differential Diagnosis ◽

Progressive Supranuclear Palsy ◽

Clinical Features ◽

Practical Approach ◽

Blink Rate ◽

Ocular Motor ◽

Eyelid Retraction ◽

Upper Eyelid ◽

Convergence Insufficiency ◽

Upper Eyelid Retraction

Supranuclear ophthalmoplegia results from an interruption of the saccadic, pursuit, optokinetic, or vergence inputs to the ocular motor nuclei. In this chapter, we begin by reviewing potential causes for difficulty reading. We next review the neuro-ophthalmic and neurologic features of progressive supranuclear palsy, which can include a vertical supranuclear ophthalmoplegia, convergence insufficiency, square-wave jerks, upper-eyelid retraction, reduced blink rate, apraxia of eyelid opening, and blepharospasm. We then discuss the differential diagnosis of progressive supranuclear palsy and point out clinical features that help to differentiate these conditions. Lastly, we present a practical approach to the management of the visual symptoms commonly caused by progressive supranuclear palsy.

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