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Progressive supranuclear palsy (PSP), also called Steele-Richardson-Olszewski syndrome, is a progressive, neurodegenerative condition consisting of parkinsonism without prominent tremor, vertical gaze palsy, axial (midline) more than appendicular (arm and leg) rigidity, early postural instability, and poor response to levodopa (Golbe and Davis 1993; Litvan 1998; Litvan et al. 1996). The syndrome was first described by Steele et al. (1964). The Society for Progressive Supranuclear Palsy estimates that 20,000 people in the United States have PSP—only 3,000–4,000 of whom have received a diagnosis—yielding an estimated known prevalence in the United States of 1.39 per 100,000. PSP is often associated with frequent falling, lack of eye contact, monotonous speech, sloppy eating, and slowed mentation (Jankovic et al. 1990). Patients may have a surprised or worried facial expression, with raised eyebrows resulting from bradykinesia and increased tone in facial musculature, and may have difficulty opening their eyes because of eyelid apraxia (Jankovic 1984). There is early suppression of vertical optokinetic nystagmus and voluntary vertical saccadic eye movements. Later in the illness, horizontal saccades and horizontal optokinetic nystagmus are also suppressed. Impairment of voluntary downgaze is more specific to PSP, whereas impairment of voluntary upgaze is nonspecific in older adults. As is expected with a supranuclear gaze palsy, passive head movement overcomes the compromised voluntary eye movements in PSP.

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