Research The Clinical Feature Of PSP

Objective Discuss the clinical manifestation,imaging findings,the results of neuropsychological assessment results,treatment and prognsis of PSP,so as to improve clinicians' recognition of PSP.Methods Collect the relevant medical records of three PSP patients of Medical College of Qingdao University and Jining Municipal Psychiatric Hospital in recent two years,r Inputting the key words " progressive supranuclearpalsy" or " Brain magnetic resonance " in WANFANG MED ONLINE and Pub Med.According to our statistics of the clinical manifestations and MRI manifestations of patients with PSP,analysis the clinical and imaging features of PSP.Results Among the patients,there were one male and two females.Two had the first symptom of staggering and two had Parkinson's symptoms.All three patients had progressive supranuclear palsy,pseudobulbar palsy and Parkinson's symptoms.In the neuropsychological test,two patients showed moderate cognitive impairment.In the MR result,one patient showed atrophy in the midbrain tegmentum area.Review the 23 PSP case literature,including 18 male and 5 female.The age of onset is between 47 and 71 years old.Merge statistics male to female ratio 2.7:1.among after 55 years old onset accounted for 96%.The initial symptoms are gait instability 12 cases(52%),parkinsonism6 cases(26%),cognitive disorders 2 cases(8%)and eye symptoms 3 cases(11%).During the course of disease,23 patients had supranuclear ophthalmoplegia,19 had pseudobulbar palsy(82%);19 had parkinsonism(82%)and 14 had cognitive and behavior disorders(60%).Among the patients who had supranuclear ophthalmoplegia,13 had supranuclear slow saccades upward and downward(68%);6 had slow saccades downward(31%);3 had slow saccades upward(15%);4 had gaze palsy(21%).pseudobulbar palsy proportion in 2 years is 25%,the emergence of pseudobulbar palsy after 2 years proportion is 75%.Among the patients with pseudobulbar palsy,6 patients had it prior to the gaze palsy(50%);3 had it after the gaze palsy(25%);3 had it synchronously with the gaze palsy(25%).Among the patients with Parkinson syndrome,17 patients had axial dystonia(89%)and 15 had limb dystonia(78%).Among the patients with cognitive and behavior disorders,9 had hypomnesia(62%);7 had calculation capacity decline(50%);4 had abepithymia(28%).In the brain MR results,12 patients had tegmentum mesencephali shrinking(63%)and 8 had “hummingbird sign”(42%).Conclusion PSP is a degenerative disease of the central nervous system(CNS)with a low prevalence.It's more common in the elderly and it happens to more men than women.The initial symptom of PSP patients are various.PSP is prone to misdiagnosis.Gait instability and balance disorder are the most common first symptoms,and is an important role in the diagnosis of PSP.Supranuclear ophthalmoplegia is the core symptoms of PSP,proportion.the typle syptoms relatively appear late,is unhelp for early diagnosis..The atrophy of the midbrain and the symptoms of "the hummingbird sign" were the characteristic features of brain MR.But the typle syptoms relatively appear late,is unhelp for early diagnosis.