Visual Hallucinations in Progressive Supranuclear Palsy

Abstract

records were collected on an annual basis and all pertinent information was entered into a database. For patients with cognitive impairment a caregiver with knowledge of the patient’s family and personal medical history completed the registry form. Upon death, remaining medical records were collected and neuropathological analyses were performed. Patients were brought to autopsy according to standardized protocols for brain handling and processing. The clinical diagnosis of PSP was made either by movement disorders specialists and/or general neurologists before death and was clearly documented in the medical fi les. Two patients were only evaluated by a general neurologist. Multiple documented neurological evaluations throughout the course of the patients’ illness were reviewed. Diagnoses were re-confi rmed after death by a movement disorders specialist (S.P.), who applied standard criteria for PSP [4] (vertical supranuclear gaze palsy, prominent postural instability, falls in the fi rst year of onset, and no evidence of other disorders to explain the neurologic fi ndings). Diagnoses of dementia and psychiatric disorders were made by the patients’ treating physicians and were clearly documented in the medical fi les. Clear documentation of dementia included diagnosis by a psychiatrist, formal psychometric testing and/or Mini-Mental State Examination ! 24 [5] . The characterDear Sir, Progressive supranuclear palsy (PSP) is the most common and best recognized atypical parkinsonian syndrome. The clinical characteristics of PSP as described by Steele, Richardson and Olszewsky [1] in 1964 include parkinsonian features, postural instability, vertical supranuclear gaze palsy, pseudobulbar symptoms and cognitive decline. However, it has been widely recognized that PSP is characterized by an ever-expanding and ‘diverse’ clinical phenotype [2] that among others includes a fl orid neuropsychiatric symptomatology [3] . This report focuses on the description of hallucinations in a small cohort of clinically and pathologically diagnosed PSP patients. Our study population consisted of 22 consecutive PSP patients. All subjects consented during life to donate their brains to the University of Miami Brain Endowment Bank TM . Brain donors were recruited and registered with the Brain Bank through a campaign performed throughout the United States over the last decade. All donors completed the Brain Bank’s PD registry form (a 128-item, self-administered questionnaire) providing information about demographics, environmental exposures, personal and family history, activities of daily living, clinical and treatment details. Yearly updates on all brain donors were obtained until death. Medical and hospital Received: July 7, 2005 Accepted: September 28, 2005 Published online: January 6, 2006