# Misdiagnosis of Frontotemporal Dementia in a Patient With Progressive Supranuclear Palsy: A Case Report and Volumetric Neuroimaging Application

## TL;DR

A 63-year-old man with progressive supranuclear palsy was initially misdiagnosed with frontotemporal dementia due to early psychiatric symptoms, highlighting the need for accurate neuroimaging.

## Contribution

This is the first reported case of PSP in Ecuador emphasizing the role of volumetric MRI analysis in early diagnosis.

## Key findings

- PSP can present with psychiatric symptoms before motor signs appear, leading to misdiagnosis.
- Volumetric MRI analysis using ITK-SNAP improved diagnostic accuracy in this case.
- CARE guidelines were followed to ensure the case report's reliability and clarity.

## Abstract

Progressive supranuclear palsy (PSP) is a tauopathy, considered a movement disorder in which the clinical features can vary through the course of the disease. Some patients could manifest motor dysfunction since the onset of the disease, while others could present with psychiatric symptoms; therefore, PSP may be misdiagnosed as a different type of atypical parkinsonism, as a psychiatric disorder, or as frontotemporal dementia due to their similar clinical manifestations and basic neuroimaging characteristics. Here we present the case of a patient with PSP whose diagnosis was delayed due to an incorrect clinical assessment and a lack of proper neuroimaging analysis. This is the first reported Ecuadorian case of a 63-year-old male with PSP, that initially presented with psychiatric symptoms of impulsivity, depression and a suicide attempt before any motor symptoms were identified. The condition was initially misdiagnosed as frontotemporal dementia and treated accordingly, delaying the correct diagnosis and management. In this case, we review the pathophysiology of psychiatric symptoms and currently available neuroimaging techniques. To assure the accuracy of this report, CARE guidelines were followed and neuroimaging analysis was carried out using the ITK-SNAP software. This case aims to highlight the benefit of an early and accurate diagnosis with the assistance of volumetric MRI analysis and discuss the pathophysiology of PSP and its relationship with neuropsychiatric manifestations as an early sign of the disease.