Early ophthalmologic manifestations of progressive supranuclear palsy: a case report with updated narrative literature review
Abstract
Objective
To highlight early ophthalmologic manifestations of progressive supranuclear palsy and emphasize their diagnostic value in clinic-radiological correlation and early disease recognition.
Methods
A 61-year-old male presenting with progressive visual disturbance, ophthalmoplegia, postural instability, and recurrent backward falls was evaluated through comprehensive ophthalmological examination and brain magnetic resonance imaging.
Results
Ophthalmological examination revealed impaired smooth pursuit, abnormal saccades, and supranuclear horizontal and vertical gaze palsy with preserved vestibulo-ocular reflexes, while visual acuity and fundus findings were normal. Brain magnetic resonance imaging demonstrated characteristic midbrain atrophy with preserved pontine structures, including the hummingbird, Mickey Mouse, and morning glory signs, supporting the diagnosis of progressive supranuclear palsy.
Conclusions
Progressive supranuclear palsy is frequently underrecognized in its early stages due to overlap with Parkinson’s disease. Detailed ocular motor examination combined with neuroimaging is crucial for early and accurate diagnosis. Increased awareness of ophthalmic manifestations may enhance early recognition and multidisciplinary management.
© 2026 Anak Agung Avrella Shora Yuananda, I Ketut Aryawan, Ida Ayu Bintang Maui Putri, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.