Vascular progressive supranuclear palsy

  • J. Winikates
  • J. Jankovic
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 42)


Background: Progressive supranuclear palsy (PSP) is a neurologic syndrome of unknown cause. This idiopathic type of PSP is usually associated with characteristic clinical and pathological features. Objective: To assess evidence of cerebrovascular disease in a population of patients with clinically defined PSP, and to compare clinical and neuroimaging features in vascular versus idiopathic PSP. Design and methods: Using predetermined criteria, the records of 128 patients diagnosed with PSP were reviewed for evidence of vascular disease. Results: Thirty patients (23.3%) satisfied criteria for vascular PSP. The vascular group differed from the idiopathic group by asymmetric and predominantly lower body involvement (p < 0.05). Corticospinal signs, pseudobulbar signs, gait difficulties, dementia, and incontinence of bowels and bladder were also more common in the vascular group, but these differences did not reach statistical significance. Conclusion: PSP is a syndrome which can be caused by cerebro-vascular disease. In addition to an increased frequency of stroke risk factors and neuroimaging evidence of vascular disease, vascular PSP can be differentiated from idiopathic PSP by a higher degree of asymmetry, lower body involvement, and evidence of corticospinal and pseudobulbar signs.


Progressive Supranuclear Palsy White Matter Change Gait Disorder Stroke Risk Factor Idiopathic Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Achiron A, Ziv I, Goren M, et al (1993) Primary progressive freeging gait. Mov Disord 8: 293–297.PubMedCrossRefGoogle Scholar
  2. Atchison PR, Thompson PD, Frackowiak RSJ, Marsden CD (1993) The syndrome of gait ignition failure: a report of six cases. Mov Disord 8: 285–292.PubMedCrossRefGoogle Scholar
  3. Critchley M (1929) Arteriosclerotic parkinsonism. Brain 52: 23–83.CrossRefGoogle Scholar
  4. Critchley M (1981) Arteriosclerotic pseudo-parkinsonism. In: Rose FC, Capildo R (eds) Research progress in Parkinson’s disease. Pitman, London, pp 40–42.Google Scholar
  5. Davis PH, Golbe LI, Duvoisin RC, Schoenberg BS (1988) Risk factors for progressive supranuclear palsy. Neurology 38: 1546–1552.PubMedCrossRefGoogle Scholar
  6. Drayer BP (1988a) Imaging of the aging brain, part I. Normal findings. Radiology 166: 785–796.PubMedGoogle Scholar
  7. Drayer BP (1988b) Imaging of the aging brain, part II. Pathological conditions. Radiology 166: 797–806.PubMedGoogle Scholar
  8. Dubinsky RM, Jankovic J (1987) Progressive supranuclear palsy and a multi-infarct state. Neurology 37: 570–576.PubMedCrossRefGoogle Scholar
  9. Dyken ML (1991) Stroke risk factors. In: Norris JW, Hachinski VC (eds) Prevent of stroke. Springer, New York.Google Scholar
  10. Dyken ML, Wolf PA, Barnett, HJM, et al (1984) Risk factors is stroke: a statement for physicians by the subcommitte on risk factors and stroke of the stroke council. Stroke 15: 1105–1111.CrossRefGoogle Scholar
  11. Eadie MJ, Sutherland JM (1964) Arteriosclerosis in parkinsonism. J Neurol Neurosurg Psychiatry 27: 237–240.PubMedCrossRefGoogle Scholar
  12. Erkinjuntti T, Haltia M, Palo J, et al (1988) Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem neuropathological study. J Neurol Neurosurg Psychiatry 51: 1037–1044.PubMedCrossRefGoogle Scholar
  13. Erkinjuntti T, Sulkava R (1991) Diagnosis of multi-infarct dementia. Alzheimers Dis Assoc Dis 5: 112–121.CrossRefGoogle Scholar
  14. Fahn S, Elton RL, and Members of the UPDRS Development Committee (1987) Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Calne D, Goldstein M (eds) Recent developments in Parkinson’s diesease, vol 2. MacMillan Healthcare Information, New Jersey, pp 153–163.Google Scholar
  15. Fazekas F, Kleinert R, Offenbacher H, et al (1993) Pathologic correlates of incidental MRI white matter signal hyperinteurities. Neurology 43: 1683–1689.PubMedCrossRefGoogle Scholar
  16. FitzGerald PM, Jankovic J (1989) Lower body parkinsonism: evidence for vascular etiology. Mov Disord 4: 249–260.PubMedCrossRefGoogle Scholar
  17. Friedman A, Kang VJ, Tatemichi TK, Burke RE (1986) A case of parkinsonism following striatal lacunar infarction. J Neurol Neurosurg Psychiatry 49: 1087–1088.PubMedCrossRefGoogle Scholar
  18. Friedman DI, Jankovic J (1989) Progressive supranuclear palsy: a quarter century of progress. In: Appel SH (ed) Current neurology, vol 9, pp 191–218.Google Scholar
  19. Gerard G, Weisberg LA (1986) MRI periventricular lesions in adults. Neurology 36: 998–1001.PubMedCrossRefGoogle Scholar
  20. Golbe LI, Davis PH, Schoenberg BS, Duvoisin RC (1987) The natural history and prevalence of progressive supranuclear palsy. Neurology 37[Suppl] 1: 121.Google Scholar
  21. Hachinski VC, Iliff LD, Zilhka E, et al (1975) Cerebral blood flow in dementia. Arch Neurol 32: 632–637.PubMedCrossRefGoogle Scholar
  22. Hachinski VC, Lassen NA, Marshall J (1974) Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet ii: 207–210.CrossRefGoogle Scholar
  23. Hershey LA, Modic MT, Greenough G, Jaffe DF (1987) Magnetic resonance imaging in vascular dementia. Neurology 37: 29–36.PubMedCrossRefGoogle Scholar
  24. Jankovic J (1989) Parkinsonism plus syndromes. Mov Disord 4: S95–S119.PubMedCrossRefGoogle Scholar
  25. Jankovic J, Friedman DI, Pirozzolo FJ, McCrary JA (1990) Progressive supranuclear palsy: motor, neurobehavioral, and neuroophthalmic findings. Adv Neurol 53: 293–304.PubMedGoogle Scholar
  26. Kinkel WR, Jacobs L, Polachini I, Bates V, Heffner RR (1985) Subcortical arterio-sclerotic encephalopathy (Binswanger’s disease): computed tomographic, nuclear magnetic resonance, and clinical correlates. Arch Neurol 42: 951–959.PubMedCrossRefGoogle Scholar
  27. Maher ER, Lees AJ (1986) The clinical features and natural history of the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Neurology 36: 1005–1008.PubMedCrossRefGoogle Scholar
  28. Moses H, Zee D (1987) Multi-infarct PSP. Neurology 37: 1819.CrossRefGoogle Scholar
  29. Murrow RW, Schweiger GD, Kepes JJ, Koller WC (1990) Parkinsonism due to a basal ganglia lacunar state: clinicopathological correlation. Neurology 40: 897–900.PubMedCrossRefGoogle Scholar
  30. Nygaard TG, Duvoisin RD, Manocha M, Chokroverty S (1986) Epileptic seizures in progressive supranuclear palsy. Neurology 36[Suppl] 1: 341.Google Scholar
  31. Parkes JD, Marsden CD, Rees JE, et al (1974) Parkinson’s disease, cerebral arteriosclerosis, and senile dementia. Q J Med 43: 49–61.PubMedGoogle Scholar
  32. Rosen WG, Terry RD, Fuld PA, et al (1980) Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 7: 486–488.PubMedCrossRefGoogle Scholar
  33. Steele JC, Richardson JC, Olszewski J (1964) Progressive supranuclear palsy: a heterogeneous degeneration involving the brain stem, basal ganglia, and cerebellum with vertical gaze and pseudobulbar palsy, nuchal dystonia, and dementia. Arch Neurol 10: 333–359.PubMedCrossRefGoogle Scholar
  34. Sullivan P, Pary R, Telang F, Rifai AH, Zubenko GS (1990) Risk factors for white matter changes detected by magnetic resonance imaging in the elderly. Stroke 21: 1424–1428.PubMedCrossRefGoogle Scholar
  35. Tanner CM, Goetz CG, Klawans HL (1987) Multi-infarct PSP. Neurology 37: 1819.CrossRefGoogle Scholar
  36. Thompson PD, Marsden CD (1987) Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger’s disease. Mov Dis 2: 1–8.CrossRefGoogle Scholar
  37. Tolosa ES, Santamaria J (1984) Parkinsonism and basal ganglia infarcts. Neurology 34: 1516–1518.PubMedCrossRefGoogle Scholar
  38. Valentine AR, Moseley IF, Kendall BE (1980) White matter abnormality in cerebral atrophy: clinicoradiological correlations. J Neurol Neurosurg Psychiatry 43:139–142.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 1994

Authors and Affiliations

  • J. Winikates
    • 1
  • J. Jankovic
    • 1
  1. 1.Department of NeurologyBaylor College of MedicineHoustonUSA

Personalised recommendations