Dysarthria as first sign of progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is a neurodegenerative disease, which causes postural instability, supranuclear vertical palsy, parkinsonism - unresponsive to L-dopa, pseudobulbar palsy and mild dementia. When fully expressed, the clinical signs of PSP are dependable for making the correct diagnosis, but not if the cardinal sign ophthalmoplegia is absent. We describe a 59-year-old man, whose first symptom was dysarthria. 3 years after the onset of PSP he showed the supranuclear vertical palsy.