Progressive supranuclear palsy (PSP): investigations

Evidence-based neurology checklist on progressive supranuclear palsy (psp): investigations: Magnetic resonance imaging (MRI) Hummingbird or Penguin sign Morning glory sign Hypointense substantia nigra sign Reduced midbrain-to-pons ratio (M/P ratio) Disproportionately enlarged subarachnoid…

Magnetic resonance imaging (MRI)

  • Hummingbird or Penguin sign
  • Morning glory sign
  • Hypointense substantia nigra sign
  • Reduced midbrain-to-pons ratio (M/P ratio)
  • Disproportionately enlarged subarachnoid haemorrhage hydrocephalus (DESH)

Positron emission tomography (PET)

Serum neurofilaments (NFL)

References

  1. Graber JJ, Staudinger R. Teaching NeuroImages: "Penguin" or "hummingbird" sign and midbrain atrophy in progressive supranuclear palsy. Neurology 2009; 72:e81. 
  2. Adachi M, Kawanami T, Ohshima H, Sugai Y, Hosoya T. Morning glory sign: a particular MR finding in progressive supranuclear palsy. Magn Reson Med Sci 2004; 3:125-132.
  3. Constantinides VC, Paraskevas GP, Velonakis G, et al. The "hypointense substantia nigra" sign. a novel MRI marker of progressive supranuclear palsy. J Neurol Sci 2021; 421:117286. 
  4. Silsby M, Tweedie-Cullen RY, Murray CR, Halliday GM, Hodges JR, Burrell JR. The midbrain-to-pons ratio distinguishes progressive supranuclear palsy from non-fluent primary progressive aphasias. Eur J Neurol 2017; 24:956-965. 
  5. Kawazoe M, Koga S, Sekiya H, Josephs KA, Grff-Radford NR, Dickson DW. Disproportionately enlarged subarachnoid-space hydrocephalus on MRI in pathologically confirmed progressive supranuclear palsy. Neurol Clin Pract 2025; 15:e200431.
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