How is multiple system atrophy (MSA) differentiated from progressive supranuclear palsy (PSP)?

Updated: Oct 17, 2018
  • Author: André Diedrich, MD, PhD; Chief Editor: Selim R Benbadis, MD  more...
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Progressive supranuclear palsy (PSP), also known as the Steele-Richardson-Olszewski syndrome, is characterized by neuronal degeneration and neurofibrillary tangles affecting the pons and midbrain. The clinical picture of PSP may be similar to that of MSA. Cardiovascular autonomic dysfunction is an exclusionary feature in the diagnosis of PSP. [29]

Analysis of the horizontal and vertical eye movements may help to distinguish PSP from MSA. Patients with PSP demonstrate slowing of saccades, which is not the situation in MSA. The trajectories of saccades made to diagonal target jumps are deviated toward the horizontal plane; because of the vertical hypometria, this is more pronounced in patients with PSP than in those with MSA. The patient with PSP may be prone to falls because of impaired downward gaze.

Persons with PSP and those with MSA demonstrate different responses to pharmacologic and physiologic stimuli in autonomic function tests. [29]

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