title: Progressive parkinsonism, balance difficulties, and supranuclear gaze palsy.
abstract: A 76-year-old man presented with a 4-year history of a progressive parkinsonian syndrome. It started with slowness of gait and mood dysfunction. Symptoms slowly progressed and further included occasional unexplained falls. On examination, he showed a severe parkinsonian syndrome featuring bradykinesia, rigidity (axial &gt; appendicular), and positive pull-test finding. Moreover, there was an upgaze supranuclear palsy and slow saccades on vertical plane. Magnetic resonance imaging was performed that revealed significant basal ganglia lesions and white matter hyperintensities, including periventricular regions and both frontal and temporal subcortical areas, along with moderate widespread atrophy and ventricular enlargement. Here, we reveal the pathological diagnosis and discuss the approach to the clinical data.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom.
authors.forename: Roberto
authors.initials: R
authors.lastname: Erro
authors.affiliation: Reta Lila Weston Institute of Neurological Studies, University College London, London, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lees
authors.affiliation: Department of Neurological Science, University Federico II, Naples, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Moccia
authors.affiliation: Department of Neurological Science, University Federico II, Naples, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Picillo
authors.affiliation: Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Penco
authors.affiliation: Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Mosca
authors.affiliation: IDC Hermitage-Capodimonte, Naples, Italy6University Parthenope, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Vitale
authors.affiliation: University of Salerno, Center for Neurodegenerative Diseases-CEMAND, Salerno, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
mesh_terms: D000368:Aged; D046589:CADASIL / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000503:physiopathology*; D013577:Syndrome; D014722:Vestibule, Labyrinth / Q000503:physiopathology*