However, several distinguishing features exist. Tremor is very common with Parkinsons, but rare with PSP. Speech and swallowing difficulties are more common and severe with PSP and the abnormal eye movements of PSP are essentially absent with PD. A poor response to levodopa along with symmetrical onset can also help differentiate PSP from PD. Patients with the Richardson variant of PSP tend to have an upright posture or arched back, as opposed to the stooped-forward posture of other Parkinsonian disorders, although PSP-Parkinsonism (see below) can demonstrate a stooped posture. Early falls are also more common with PSP, especially with Richardson syndrome.PSP can also be misdiagnosed as Alzheimers disease because of the behavioral changes.Chronic traumatic encephalopathy shows many similarities with PSP. Management
Treatment
No cure for PSP is known, and management is primarily supportive. PSP cases are often split into two subgroups, PSP-Richardson, the classic type, and PSP-Parkinsonism, where a short-term response to levodopa can be obtained. Dyskinesia is an occasional but rare complication of treatment. Amantadine is also sometimes helpful. After a few years the Parkinsonian variant tends to take on Richardson features. Other variants have been described. Botox can be used to treat neck dystonia and blepharospasm, but this can aggravate dysphagia.Two studies have suggested that rivastigmine may help with cognitive aspects, but the authors of both studies have suggested a larger sampling be used. There is some evidence that the hypnotic zolpidem may improve motor function and eye movements, but only from small-scale studies.
more than 2 mm horizontal or downsloping ST segment depression in non-Q wave leads, or marked axis shift
Arrhythmias other than sustained ventricular tachycardia e.g. Premature ventricular contractions, both multifocal or triplet; heart block; supraventricular tachycardia or bradyarrhythmias
Intraventricular conduction delay or bundle branch block or that cannot be distinguished from ventricular tachycardia
Increasing chest pain
Fatigue, shortness of breath, wheezing, claudication or leg cramps
Hypertensive response (systolic blood pressure > 250 mmHg or diastolic blood pressure > 115 mmHg)

Adverse effects
Side effects from cardiac stress testing may include
Palpitations, chest pain, myocardial infarction, shortness of breath, headache, nausea or fatigue. Adenosine and dipyridamole can cause mild hypotension. As the tracers used for this test are carcinogenic, frequent use of these tests carries a small risk of cancer. Pharmacological agents
Pharmacologic stress testing relies on coronary steal. Vasodilators are used to dilate coronary vessels, which causes increased blood velocity and flow rate in normal vessels and less of a response in stenotic vessels. This difference in response leads to a steal of flow and perfusion defects appear in cardiac nuclear scans or as ST-segment changes.The choice of pharmacologic stress agents used in the test depends on factors such as potential drug interactions with other treatments and concomitant diseases. Pharmacologic agents such as adenosine, Lexiscan (regadenoson), or dipyridamole is generally used when a patient cannot achieve adequate work level with treadmill exercise, or has poorly controlled hypertension or left bundle branch block.