The Early Ophthalmologic Manifestations of Progressive Supranuclear Palsy: A Case Report with Updated Narrative Review

Abstract

Objective:

To highlight early ophthalmologic manifestations of progressive supranuclear palsy and emphasize their diagnostic value in clinicoradiological correlation and early disease recognition.

Methods:

A 61-year-old male presenting with progressive visual disturbance, ophthalmoplegia, postural instability, and recurrent backward falls was evaluated through comprehensive ophthalmological examination and brain magnetic resonance imaging.

Results:

Ophthalmological examination revealed impaired smooth pursuit, abnormal saccades, and supranuclear horizontal and vertical gaze palsy with preserved vestibulo-ocular reflexes, while visual acuity and fundus findings were normal. Brain magnetic resonance imaging demonstrated characteristic midbrain atrophy with preserved pontine structures, including the hummingbird, Mickey Mouse, and morning glory signs, supporting the diagnosis of progressive supranuclear palsy.

Conclusions:

Progressive supranuclear palsy is frequently underrecognized in its early stages due to overlap with Parkinson’s disease. Detailed ocular motor examination combined with neuroimaging is crucial for early and accurate diagnosis. Increased awareness of ophthalmic manifestations may enhance early recognition and multidisciplinary management.

Keywords: Progressive supranuclear palsy, Ophthalmic manifestations, Ocular motor dysfunction