CASE REPORT Co-existence of Parkinson’s disease and progressive supranuclear palsy: case report and a review of the literature Kumar Abhinav • Laura Marsh • Barbara Crain • Stephen G. Reich • Kevin Biglan Received: 8 April 2009 / Accepted: 16 July 2010 / Published online: 25 August 2010 Ó Springer-Verlag 2010 Abstract Idiopathic Parkinson’s disease (PD) and pro- gressive supranuclear palsy (PSP) are distinct clinicopath- ological entities characterized by a-synuclein and tau pathology, respectively. They have occasionally been reported to co-exist in the same patient. We describe a rare case of a 73-year-old Caucasian woman diagnosed as idi- opathic PD 5 years before her death yet at autopsy had not only PD, but also PSP. Although this patient fulfilled clinical criteria for idiopathic PD and did not have supra- nuclear ophthalmoplegia, she had several atypical features, including early postural instability with falls, early dys- phagia, and a relatively rapid course. In conclusion, this case and a literature review highlight the co-existence of synuclein and tau pathology in the same patient and demonstrate that multiple diagnoses may exist in patients presenting with parkinsonism. The clinical heterogene- ity seen in parkinsonism may reflect the occurrence of combined pathology. Keywords Parkinson’s disease (PD) Á Progressive supranuclear palsy (PSP) Á Parkinsonism Á Neuropathology Introduction Idiopathic Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) are distinct clinicopathological entities characterized by a-synuclein and tau pathology, respectively [1, 2]. We report a rare case with a clinical diagnosis of PD, but with a subsequent pathological diag- nosis of combined PD and PSP. K. Abhinav Department of Neurosurgery, Frenchay Hospital, Bristol, UK L. Marsh Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA L. Marsh Á K. Biglan Department of Neurology and Neurological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA B. Crain Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA S. G. Reich Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA Present Address: L. Marsh Michael E. DeBakey Veterans Affairs Medical Center, Menninger Department of Psychiatry and Department of Neurology, Baylor College of Medicine, Houston, TX, USA Present Address: K. Biglan (&) Department of Neurology, University of Rochester, 1351 Mt. Hope Avenue, Suite 223, Rochester, NY 14620, USA e-mail: kevin.biglan@ctcc.rochester.edu K. Abhinav (&) 4, Garden Flat, Gordon Road, Clifton, Bristol BS8 1AP, UK e-mail: kumar.abhinav@doctors.org.uk 123 Neurol Sci (2011) 32:159–163 DOI 10.1007/s10072-010-0386-2