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Clinical signs in progressive Supranuclear Palsy

Omega sign: The term omega sign refers to wrinkles in the shape of the Greek letter Ω above the root of the nose caused by tonic contraction of the corrugator

Procerus sign: This sign is a wrinkle on the forehead between the eyebrows that is often seen in people with PSP. focal dystonia of the procerus muscle.

Astonished face: This refers to a facial expression where the person's eyes are wide open and the eyebrows are raised, giving the appearance of surprise or astonishment. This is a common feature in PSP.

Collier's sign: This sign refers to the inability of the person to look downward. When attempting to look down, the person's head and neck will tilt backwards.

Mona Lisa gaze: This is a characteristic facial expression seen in people with PSP where the person appears to be looking straight ahead but has a fixed, unblinking stare.

Pretarsal blepharospasm: This refers to the involuntary twitching or spasm of the muscles that control the eyelids.

Apraxia of eyelid opening: This refers to the inability of the person to voluntarily open their eyes. The person may appear to be asleep or have their eyes closed, even when attempting to open them.

Vertical gaze palsy: This refers to the inability of the person to move their eyes up or down. The person may have difficulty looking up or down, or their eyes may remain fixed in a straight-ahead position.

Diplopia: This is also known as double vision, and it occurs when the person sees two images of a single object. It is often caused by the inability of the eyes to align properly.

Round house phenomenon:

This refers to a phenomenon where the person's eyes move in a circular motion when attempting to look in a particular direction. curved trajectory of vertical saccades

Loss of optokinetic nystagmus: Optokinetic nystagmus is a normal eye movement that occurs when the person is viewing a moving object. In PSP, the person may have difficulty with this eye movement, which can affect their ability to track moving objects.

Square wave jerk: This refers to an abnormal eye movement where the eyes move back and forth rapidly in a jerky motion. This is often seen in people with PSP. Square-wave jerks, in which the eyes oscillate horizontally across the midline during visual fixation is an early eye sign.

Visual grasping: This is a phenomenon where the person reaches out to grasp objects that are not there, or they may reach out to objects that are not in the intended location. Visual graspingit is the eye deviation and intermittent head turns towards object the patients have walked past often mistaken as cervical dystonia.

Impaired antisaccade: An antisaccade is a type of eye movement where the person looks away from a stimulus. In PSP, the person may have difficulty with this eye movement, which can affect their ability to direct their attention and gaze.

Growling dysarthria: Dysarthria is a motor speech disorder that affects the muscles involved in speech production. In PSP, dysarthria may be present with a specific type of speech pattern where the voice becomes low-pitched, rough and strained. This is sometimes referred to as growling dysarthria.

Dirty tie sign: This sign refers to a pattern of spilling food or drink on the front of the shirt or tie, which is commonly seen in individuals with PSP. This is thought to be due to the difficulty in controlling head and neck movements.

Arm levitation: In PSP, some individuals may have a tendency to hold their arms out in front of them with the hands elevated, as if they were holding an invisible tray. This is called arm levitation.

Pillow sign: this is due to the axial rigidity so when the patient is asked to lie down they appear as if they are using artificial pillow

Applause sign: The applause sign is a phenomenon where the individual with PSP continues to clap even after the rest of the audience has stopped. This is thought to be due to a delay in processing information.

The ‘Rocket sign’: This is the manifestation of motor impulsivity in Progressive Supranuclear Palsy (PSP). Patients with PSP may suddenly jump to their feet from a sitting posture without assistance, a manifestation of disinhibition and failure of planning, only to topple backwards into the chair because of postural instability, axial rigidity and bradykinesia. This sudden forward movement followed by the backward fall is known as the ‘Rocket sign’.1 Though ‘Rocket sign’ describes mainly backward falls, patients can fall to other directions also.2 The combination of frontal lobe and extrapyramidal dysfunction makes this sign specific to a very limited set of diseases like PSP.

Gun-slinger's gait: In PSP, some individuals may develop a characteristic gait where the legs are spread apart and the arms are held stiffly at the sides, as if holding a gun. This is called the gun-slinger's gait.

Cognitive dysfunction : Cognitive dysfunction, also known as cognitive impairment or cognitive disorder, refers to a decline or disruption in a person's mental processes that affects their ability to think, learn, remember, concentrate, or make decisions. Cognitive dysfunction can occur due to various causes, including neurological disorders, brain injury, mental health issues, substance abuse, or age-related cognitive decline.