A case of progressive supranuclear palsy presenting with progressive dynamic aphasia

<p>We describe a case of progressive supranuclear palsy (PSP) presenting with progressive dynamic aphasia. A 71-year-old, right-handed, male patient visited our hospital complaining of forgetfulness, speech disturbance, and walking difficulties. Ten days later, he fell down and fractured his left femoral neck; this injury was treated at the orthopedics ward. Neurologically, he displayed downward vertical gaze limitations, bradykinesia in the left upper and lower extremities, and postural instability leading to frequent falls. Brain magnetic resonance images revealed atrophy of the bilateral frontal lobes and the tegmentum of the midbrain. Therefore, we diagnosed his condition as PSP-Richardson syndrome in accordance with the diagnostic criteria of the Movement Disorder Society. His spontaneous speech was highly sparse, but he had no disturbance in naming, repetition, reading or comprehension; these features were highly consistent with dynamic aphasia. His verbal condition deteriorated gradually, displaying the features of prosodic-type apraxia of speech as well as worsening of dynamic aphasia. Single-photon emission computed tomography (SPECT) images of the head performed at this time showed decreased blood flow in the predominant right side of the frontal lobes and basal ganglia.</p><p>Recently, several cases of progressive dynamic aphasia have been reported, most of which have been diagnosed as frontotemporal lobar degeneration including PSP. We speculate that functional disorders in the bilateral frontal cortical and subcortical areas, including the basal ganglia, might contribute to the emergence and evolution of dynamic aphasia and apraxia of speech. Accumulation and chronological examinations of similar cases to ours could elucidate the pattern of the pathological progression in the speech disorders associated with PSP.</p>