Vertical wrinkling of the forehead or Procerus sign in Progressive Supranuclear Palsy

Abstract

'Procerus sign' has been described as vertical wrinkles in the glabella region and bridge of the nose of patients with Progressive Supranuclear Palsy. The action of Corrugator and Orbicularis Oculi produce the vertical wrinkling. The relevance of this sign in early clinical diagnosis has been established and this sign has gained importance in literature and has been quoted as a useful sign in texts following the original description. We prospectively performed a cross sectional analysis of the facial appearance in subsequent Parkinsonism patients and found statistically significant presence of this sign in PSP compared to other Parkinsonian disorders. We recommend that this should be called "vertical wrinkling of the forehead" to avoid confusion and emphasize the dystonic nature of this condition rather than contraction of a single muscle as indicated by 'Procerus sign'.