A 76 year old male comes with a history of frequent falls and difficulty in looking downwards and laterally. The diaganosis is

Ans. is 'b' i.e.,. Supranuclear palsy. Progressive Supranuclear palsy is also known as steel Richardson syndromeIt's a degenerative disorder as their occurs loss of neurons in parts of C.N.S. which are involved with maintenance of posture and equilibrium namely.Mid brainPonsBasal ganglionCerebellumC/F are characteristic" Progressive Supra nuclear palsy should be considered whenever a middle aged or elderly person presents with history of repeated falis and has an extrapyramidal syndrome accompanied by nuchal Dystonia and paralysis of voluntary/' Downgaze.Factors which distinguish this from Parkinson's disease are -Marked impairment of voluntary Downward gaze and horizontal gaze .Extended rather than flexed dystonic postureAbsence of Tremor .Poor response to Antiparkinsonian medication .