Abstract
Functional movement disorders (FMD) are thought to account for around 10% of new patients at large movement disorder clinics. Among patients with FMD, only 5% have functional parkinsonism. Functional progressive supranuclear palsy (PSP) likely accounts for a very small proportion of these patients. Despite a literature search, I was not able to find any case description of functional PSP. I report an interesting and rare case of functional parkinsonism very closely mimicking PSP.
A 70-year-old NZ European man presented to the Emergency Department following a collapse and progression of symptoms related to his previously diagnosed PSP, making him unable to manage at home. He had frequent falls, shuffling gait, slow movements, right sided limb tremor along with difficulty with eye movements, dysphagia and several collapses. On examination, he had gait and other features of parkinsonism (tremor, bradykinesia, rigidity and postural instability). He also had ophthalmoparesis, suggestive of PSP.
However, there were some incongruencies that prompted for a more detailed examination. This revealed subtle but definite features in keeping with functional parkinsonism. The patient was referred to physiotherapy and cognitive behavioural therapy. He is also awaiting a dopamine transporter imaging.
During my oral presentation, I will be showing videos of this patient’s examination findings and present a literature review. This case demonstrates how easy it is to miss the signs if they are not carefully and actively looked for. It also highlights the importance of challenging and digging deeper when things do not quite fit.
