Hummingbird sign in progressive supranuclear palsy disease
A 72 year-old lady with gradually progressive history of slowness, frequent falls, rigidity and forgetfulness for 2 years was referred to us. She was initially diagnosed as a case of Parkinson's disease and was thus treated with levodopa/carbidopa for 3 months. She did not show any improvements in her symptoms and was referred to our hospital. On examination, she was having predominantly frontal lobe dysfunctions in the form of repetitive failure to perform executive function. She also had difficulty in calculation and recent memory. She had marked limitation in downgaze with slowing of horizontal saccades.\nShe had foot dystonia and rigidity in all 4 limbs including neck and trunk. Motor power was normal and deep tendon reflexes were within normal limit. Her gait was slow with lack of arm swing on both sides and tendency to fall backward.\nDue to early onset of falls, dementia, predominant parkinsonian features and poor response to levodopa/carbidopa, a diagnosis of PSP was made. MRI of brain was conducted to rule out secondary causes of Parkinson's disease. MRI was suggestive of predominant atrophy of midbrain and preservation of pons and medulla ().