THE UNSUSPECTING HUMMINGBIRD
Progressive supranuclear palsy is a neurodegenerative disease with several diagnostic challenges. Diagnosis is often based on the cardinal clinical features of supranuclear gaze palsy, bradykinesia and problems with balance with recurrent falls. MR imaging of the brain has allowed for the identification of characteristic features of midbrain atrophy, known as the “hummingbird” sign, diagnosing several patients who would have for example previously been labeled as having Parkinson’s disease. This case describes the incidental finding of midbrain atrophy on MR brain of a patient being worked-up for a cerebrovascular accident. The radiological sign identified triggered consideration of progressive supranuclear palsy as an explanation to several previously-overlooked features that the patient was exhibiting. A brief literature review and discussion of the case with respect to clinical correlates and diagnostic criteria will be detailed at the end of the case report.