Objective: To investigate the clinical and MRI/CT radiological correlation to improve the diagnosis and management of PSP

Background: PSP is a rare progressive neurodegenerative disease mostly affecting elderly patients. It is characterized by cognitive impairment, abnormal eye movements, postural instability, and falls. MRI/CT imaging features could be suggestive of PSP including the hummingbird sign characterized by the atrophy of the midbrain with the preservation of the pons.

Method: The clinical notes of patients diagnosed with PSP at the Royal Berkshire NHS Foundation Trust, United Kingdom from 2008 to present were reviewed. Data was collected on demographics, presenting symptoms, motor and non-motor features, clinical signs and response to levodopa. The radiological reports of their MRI/CT head scans were then reviewed.

Results: 22 patients with PSP were reviewed. The hummingbird sign was present in 72.73% (16/22) of the patients. Red flag signs included early falls in 59% (13/22), cognitive impairment in 63% (14/22) and poor response to levodopa in most patients. Table 1 shows the distribution of symptoms and signs in relation to the radiological finding of a positive (H+) or negative (H-) hummingbird sign.

Conclusion: The hummingbird sign is a common radiological finding in PSP, especially in male patients. H+ patients are associated with increased falls, functional dependence, and requirement for nursing home as well as non-motor symptoms including visual hallucination, RBD, mood disorders and sialorrhea. However, both H+ and H- patients have poor response to levodopa. Therefore, the hummingbird sign can be suggestive of the diagnosis of PSP and useful in predicting the presence of motor and non-motor symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-retrospective-review-of-clinical-and-mri-ct-radiological-correlation-in-progressive-supranuclear-palsy-psp/