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The odds oppose clinicians attempting to diagnose progressive supranuclear palsy (PSP). The result is that the median time from symptom onset to a correct diagnosis is 3 to 4 years, halfway through the median disease course.1
One reason for the delay is that the pathology of PSP involves most levels of the CNS from frontal neocortex to sacral cord, creating a complex and variable clinical picture, albeit one that emphasizes the rostrodorsal brainstem. PSP often mimics better-known diagnostic alternatives such as Parkinson disease early on. This is especially true for the recently described “PSP-parkinsonism” variant, which comprises a quarter of cases of PSP.2 The lack of specific treatment further reduces the diagnostic imperative. Perhaps most important, there is no objective diagnostic test for PSP in its early stages.
Why buck the odds? Early diagnosis spares patients unnecessary workups and treatment for vestibulopathy, vertebrobasilar vasculopathy, epilepsy, and cervical spondylotic myelopathy. It allows patients and their families to plan logistically and psychologically …
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