An elderly man presents with features of dementia, ataxia, difficulty in downward gaze and a history of frequent falls. Likely diagnosis is:

Answer is B (Supranuclear gaze palsy): Progressive supranuclear palsy should always be considered when a middle aged/elderly persons presents with a history of repeated falls, & difficulty in downward or horizontal gaze. Steel Richardson syndrome Nature of disorder Is a degenerative disorder where in there occurs loss of neurons in pas of our CNS which are involved with maintenance of posture & equilibrium, namely the Mid brain, Pons, Basal ganglion and cerebellum. The clinical features are characteristic "Progressive supranuclear palsy should be considered whenever a middle aged or elderly person person presents with history of repeated falls and has an extrapyramidal syndrome accompanied by nuchal dystonia and paralysis of voluntary down gaze" Factors which distinguish this from Parkinson's marked impairment of voluntary downward gaze and horizontal gaze. extended rather than flexed dystonic posturing absence of tremor poor response to antiparkinsonian medication