Progressive Supranuclear Palsy with Predominant Speech/Language Disorder

We herein report a rare case of progressive supranuclear palsy (PSP) that initially presented as progressive fluent aphasia and echolalia. A 75-year-old woman exhibited significant language impairments for 2 years before developing motor symptoms, including vertical gaze palsy and frequent falls. Neuroimaging revealed asymmetric frontal and midbrain atrophy, with reduced perfusion in the left frontal and parietal lobes. This case highlights the importance of recognizing atypical PSP presentations, particularly language-dominant variants that may mimic other neurodegenerative disorders. Early identification using detailed neuropsychological assessments and imaging may facilitate a timely diagnosis and intervention in non-classical PSP cases.