months later because of fever up to 39.2 ° C. On neurological examination, he was fully conscious but apathic and had little vigor. He also had impaired concreteness in thinking, slowed information processing and decreased verbal fluency. He had apparent dementia and scored 14/30 points on HDS-R (Hasegawa Dementia Rating Scale – Revised) showing disturbance in orientation, recent memory, and word remembrance and recall. Extraocular movements were normal, except for some slowing of vertical saccades. His face was oily and mask-like. Myerson sign and palmomental reflex were absent. Rigidity was marked in his neck and to a lesser extent in his arms. Bradykinesia, dysarthria and dysphagia were also present. Postural tremor was observed in the limbs and the trunk. Limb ataxia was seen in his left arm. Neither motor weakness nor sensory disturbance was found. It was impossible for him to maintain a sitting position or stand up. Deep tendon reflexes were diminished in the distal part of extremities. Babinski and Chaddock signs were flexor. Laboratory examinations disclosed slight anemia and hypo-albuminemia. Chronic atrial fibrillation was noted. A chest roentgenogram was normal. Diffuse brain atrophy was seen on brain MRI, but there was no obvious atrophy of the tecDear Sir, Progressive supranuclear palsy (PSP), first described in 1964  , is a part of the atypical parkinsonian syndrome. Here we report a patient with the clinical diagnosis of possible PSP, based on the proposed clinical criteria  . The brain contained microscopic lesions positive for 4-repeat (4R) tau compatible with PSP, but the frequency of lesions was much less than that defined by current operational criteria for histological diagnosis of PSP [3, 4] .
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