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LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 3  |  Page : 484-485

Progressive supranuclear palsy like syndrome: Neurocysticercosis an unusual cause


Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India

Date of Submission07-May-2011
Date of Decision09-May-2011
Date of Acceptance09-May-2011
Date of Web Publication7-Jul-2011

Correspondence Address:
Ravindra Kumar Garg
Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.82763

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How to cite this article:
Sharma P, Garg RK, Somvanshi DS, Malhotra HS. Progressive supranuclear palsy like syndrome: Neurocysticercosis an unusual cause. Neurol India 2011;59:484-5

How to cite this URL:
Sharma P, Garg RK, Somvanshi DS, Malhotra HS. Progressive supranuclear palsy like syndrome: Neurocysticercosis an unusual cause. Neurol India [serial online] 2011 [cited 2019 Sep 15];59:484-5. Available from: http://www.neurologyindia.com/text.asp?2011/59/3/484/82763


Sir,

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder which occurs rarely, and only a few patients of progressive supranuclear palsy like syndrome with acquired causes have been described. [1],[2] We report progressive supranuclear palsy like syndrome in a patient with neurocysticercosis.

A 64-year-old man presented with gradually progressive difficulty in walking, frequent backward falls and change in speech since one and half year. Attendants also noticed progressive cognitive decline. On examination, patient was conscious, oriented, and attentive. His speech was hypophonic and spastic. Mini mental status examination revealed a score of 16. He had impaired recent memory and calculations. Perseveration and emotional lability were present. He had gaze restriction in all direction with vertical gaze much more affected than horizontal. In vertical, up-gaze was more restricted than down-gaze. Vertical saccades were absent and horizontal saccades were slow. Axial rigidity was present with positive pull test. Primitive reflexes were present. There was no motor weakness. Deep tendon reflexes were brisk bilaterally. Plantar responses were flexor. Gait was slow with short and low steps. Hematological and blood biochemical parameters were normal. Enzyme-linked immunosorbent assay (ELISA) for neurocysticercosis was positive while ELISA for human immunodeficiency virus was negative. Magnetic resonance T1, T2, and Fluid Attenuated Inversion Recovery (FLAIR) images of the brain showed multiple ring shaped cystic lesions (hypointense on T1 and hyperintense on T2). The vesicular lesions of neurocysticercosis were present in both the cerebral hemispheres, especially in the temporal lobes, and also in the dorsal and tegmental areas of the midbrain [Figure 1]. Patient was treated with 2 weeks course of albendazole along with dexamethasone. No complication of albendazole therapy was noted. After 2 months of follow-up there was no significant change in the disability status of the patient. Follow up neuroimaging was not done.
Figure 1: Magnetic resonance imaging brain showing multiple vesicular lesions of neurocysticercosis in dorsal midbrain and tegmentum of midbrain. Multiple lesions are also present through the cortex

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Diagnosis of PSP is based mainly on clinical criteria and there are no laboratory tests to confirm the diagnosis.[3] Essential criteria suggested by National Institute for Neurological Diseases and Stroke-Society for PSP include presence of vertical supranuclear gaze palsy/slowing of vertical saccades and postural instability with recurrent falls. [4] Clinically our patient had progressive supranuclear palsy like syndrome. However, some of the manifestations were not suggestive of PSP, including early cognitive decline with prominent memory and calculation deficits. Neuroimaging of the brain revealed presence of multiple cystic lesions suggestive of neurocysticercosis. [5] Our patient suggests that neurocysticercosis may present with progressive supranuclear palsy like syndrome.

 
  References Top

1.Tan JH, Goh BC, Tambyah PA, Wilder-Smith E. Paraneoplastic progressive supranuclear palsy syndrome in a patient with B-cell lymphoma. Parkinsonism Relat Disord 2005;11:187-91.  Back to cited text no. 1
    
2.Kim HT, Shields S, Bhatia KP, Quinn N. Progressive supranuclear palsy-like phenotype associated with bilateral hypoxic-ischemic striopallidal lesions. Mov Disord 2005;20:755-7.  Back to cited text no. 2
    
3.Litvan I, Agid Y, Jankovic J, Goetz C, Brandel JP, Lai EC, et al. Accuracy of clinical criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome). Neurology 1996;46:922-30.  Back to cited text no. 3
    
4.Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, McKeith I, et al. Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Disord 2003;18:467-86.  Back to cited text no. 4
    
5.Garg RK. Diagnostic criteria for neurocysticercosis: Some modifications are needed for Indian patients. Neurol India 2004;52:171-7.  Back to cited text no. 5
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