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NEUROLOGY 2009;72:e81
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: "Penguin" or "hummingbird" sign and midbrain atrophy in progressive supranuclear palsy

Jerome J. Graber, MD, MPH and Robert Staudinger, MD, FAAN

From the Department of Neurology, New York University School of Medicine; and Department of Neurology, New York Harbor Veteran's Affairs Medical Center, New York.

Address correspondence and reprint requests to Dr. Jerome J. Graber, Department of Neurology, New York University School of Medicine, NBV7W11, 462 First Avenue, New York, NY 10016 Jerome.Graber{at}nyumc.org

An 82-year-old man presented to us with a 2-year history of progressive difficulty walking. On examination, he had bradykinesia, bradyphrenia, axial rigidity without appendicular rigidity, cogwheeling, or tremor, and restriction of upward and downward gaze. Imaging revealed prominent midbrain atrophy without pontine atrophy, referred to as the "penguin" or "hummingbird" sign (figure), which may be helpful in distinguishing progressive supranuclear palsy from multisystem atrophy, Parkinson disease, and healthy controls.1,2


Figure 117
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  		Figure Midsagittal MRI of the brain demonstrates prominent midbrain atrophy without pontine atrophy (divided by white line), forming the silhouette of the "penguin" or "hummingbird" sign

 

Disclosure: The authors report no disclosures.


   REFERENCES
Top.
 REFERENCES
 

  1. Oba H, Yagashita A, Terada H, et al. New and reliable MRI diagnosis for progressive supranuclear palsy. Neurology 2005;64:2050–2055.[Abstract/Free Full Text]
  2. Kato N, Arai K, Hattori T. Study of the rostral midbrain atrophy in progressive supranuclear palsy. J Neurol Sci 2003;210:57–60.[Medline]




This Article
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Right arrow All Movement Disorders
Right arrow Gait disorders/ataxia
Right arrow Progressive supranuclear palsy

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