THE DIAGNOSIS of supranuclear palsy seems to be peculiarly difficult for physicians other than neurologists. The neurologist may recognize it at a glance, mainly because of the typical facies. The diagnosis naturally is abetted by a history of previous stroke. In 1940, Langworthy and Hesser 1 wrote what has become the classical description of the syndrome. There is little to add to their careful exposition which should be reading required of the medical student assigned a patient with the disorder.
Some discussion of the terminology is appropriate. The term "pseudobulbar" has gathered the patina of age, always difficult to dislodge. Pseudobulbar was used originally to point up the differentiation from bulbar palsy, not an especially difficult task. Bulbar palsy has become considerably less prevalent with the control of poliomyelitis. It is now rarely seen except in amyotrophic lateral sclerosis. Then there is weakness of the muscles supplied from the medulla.