Procerus Sign

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Procerus sign.jpg

Like risus sardonicus, procerus sign is a facial dystonia. It is seen most characteristically in progressive supranuclear palsy and corticobasal degeneration. There is contraction of the forehead muscles, particularly the procerus and corrugator, with knitting of the brows, raised eyebrows, lid retraction, widening of the palpebral fissures and reduced blinking. The expression is one of surprise, astonishment, perplexity or consternation. The facial masking (hypomimia) of Parkinson’s disease is quite different. This patient was seen with a diagnosis of Parkinson’s disease but instead had PSP.

The term omega sign refers to wrinkles in the shape of the Greek letter Ω above the root of the nose caused by tonic contraction of the corrugator and has also been used to describe this facial appearance. In the older literature, omega sign was used to describe the facial appearance seen in depression.

References

Morimatsu M. Procerus sign in progressive supranuclear palsy and corticobasal degeneration. Intern Med 2002;41:1101–1102.

Batla A, Nehru R, Vijay T. Vertical wrinkling of the forehead or Procerus sign in Progressive Supranuclear Palsy. J Neurol Sci. 2010; 298:148-149.

Romano S, Colosimo C. Procerus sign in progressive supranuclear palsy. Neurology 2001;57:1928.