Description
A 76 year old man was referred to a falls clinic with a twelve month history of recurrent falls preceded by episodes of instability. He had a previous history of prostatic carcinoma, transient ischaemic attacks and hypertension. On examination he had reduced facial expression, severe limitation of vertical gaze, increased tone and mild bradykinesia in both upper limbs. He also had left sided cerebellar signs and postural instability. Figure 1 shows one of the images obtained from his MRI brain. His neurological signs changed rapidly, with new clinical findings of dysarthria and loss of eye movements in all direction. A Parkinsons plus syndrome was considered, prompting a DaT scan to be performed (Figure 2).
