[Steele-Richardson-Olszewski syndrome]

Basal ganglia diseases with an akinetic-rigid symptom manifest like a Parkinson disease or an atypical Parkinson syndrome. Their symptoms are similar and therefore a diagnosis often is only possible after long-standing care of the patient. In the class of the atypical Parkinson syndromes is the progressive supranuclear palsy (PSP), which is also known as Steele-Richardson-Olszewski syndrome.

A seventy-year-old patient who reported unaccountable sudden drops and disturbances of balance as well as diplopia in near vision was examined and a retrospective analysis of the case history was carried out.

Only long-standing observation of the patient rendered the suspected diagnosis of a progressive supranuclear palsy (PSP) possible. Only after determination of the clinic picture of a vertical palsy to the up and the down direction and a bad optokinetic nystagmus with an existing vertical vestibular reflex could the clinical diagnosis of PSP be confirmed.

In cases with the combination of a vertical palsy, an akinetic-rigid Parkinson syndrome, pyramidal tract signs and subcortical dementia, the diagnosis of a suspected progressive supranuclear palsy should be made. L-Dopa medication has very little or no influence on PSP. At present, however, a certain diagnosis is only possible post-mortem, in spite of helpful clinical diagnostics.