This document describes a case study of a rare cause of dementia in a 62-year old male patient. The patient had been experiencing memory, thinking, speaking, swallowing, and balance difficulties for two years. A neurological examination revealed dysarthria, opthalmoplegia, dysphagia, rigidity, and weight loss. MRI scans showed diffuse ischemic focuses and midbrain atrophy characteristic of Progressive Supranuclear Palsy (PSP), an uncommon cause of dementia. Based on the clinical symptoms and MRI findings, PSP was diagnosed as the cause of the patient's dementia.

1. Case of patient
with a rare cause
of dementia
Students: Natalia Fornal, Dominik Grzebyk
Scientific supevisor: dr n. med. Joanna
Bielewicz
Students’ Scientific Society,
Departament of Neurology,
Medical University of Lublin,
Poland

2. BACKGROUND
Dementia
• often progressive
• mainly affects the elderly
• risk for dementia- aging, smoking,
diabetes, hypertension, alcohol
term to describe a set of symptoms,
characterized by a cognitive disturbance

3. BACKGROUND
Manifestation of Dementia
• memory insufficiency
• problems with thinking, orientation,
learning and problem solving,
• ability to focus and pay attention
• worsening of control emotions
• behavioral changes
• reduced motor function

4. BACKGROUND
• up to half of people ages 85 and older may
have Alzheimer’s disease- most common
cause of dementia
• vascular dementia,
• Lewy body disease
• frontotemporal dementia
• about 46 million people in 2015 afected

5. BACKGROUND
• neurodegenerative (tauopathy)
• slowly progress
• unknown cure
• diagnosed late nonspecific signs
Uncommon cause of dementia is
Progessive Supranuclear Palsy (PSP)

6. BACKGROUND
PSP CRITERIA
http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2013;volume=6;issue=3;spage=342;epage=345;aulast=Gokhale

7. CASE REPORT
• to diagnose increasing cognitive disturbances
Symtopms from last two years:
• memory, thinking and performance disturbances
• patient also complained to speaking, swallowing and
balance difficulties
62 years old male patient was admitted to Neurological Clinic
in July 2017

8. CASE REPORT
CURRENT NEUROLOGICAL EXAMINATION
dysartria
opthalmoplegia with impaired
vertical movement
dysphagia
rigidity, especially in right side
In last two months patient lost 5 kg
weight

9. CASE REPORT
MMSE-16 Clock Drawing
test 0/10
difficulties in calculation
and writing
difficulties in attention and
concentration
Psychological
examination
severe
cognitive
impairment

10. CASE REPORT
MRI detected
• diffuse ischemic focuses
• atrophy of the midbrain (mainly in tegmentum)  characteristic
Hummingbird sign
Another tests, clinical examination excluded other causes of
dementia, CNS inflammatory diseases and paraneoplasmatic
syndroms
Clinical symptoms and MRI proved PSP
diagnosis

11. „Mickey-
Mouse” sign

12. „Hummingbird
” sign or
„Pinguin” sign

13. CONCLUSIONS
• dementia is very common in neurological
practice
• it is necessary to control patients with dementia
regulary
• occuring of a new symptoms, which are not
connected with dementia, should determine
extension of examination
• it is important to take into consideration another
uncommon causes of dementia

14. Thank You for Your attention!