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

Diagnostic Approach to Atypical Parkinsonian Syndromes

“…In addition, patients may also experience photosensitivity (wearing sunglasses inside), decreased eye blink, blepharospasm, and eye-opening apraxia, leading to eyebrow furrowing (procerus contraction), and vertical wrinkling of the forehead, referred to as procerus sign. 5 Additional symptoms include a characteristic facial appearance from the rigid bradykinesia and dystonia in facial musculature. The hypertonic facial muscles produce facial folds and a worried, astonished expression.…”

Recognizing Atypical Parkinsonisms: “Red Flags” and Therapeutic Approaches

“…Eyebrow furrowing (procerus contraction) and vertical wrinkling of the forehead are common, referred to as the "Procerus sign." 18 Bulbar symptoms include progressive dysarthria characterized by spastic, hypernasal, hypokinetic, and monotonous speech. Stuttering, echolalia, and occasional involuntary vocalizations may also be present, as well as an apraxia of phonation.…”

Procerus sign: Mechanism, clinical usefulness, and controversies

“…However, the generation of the vertical wrinkles is a complex event and involves the contraction of corrugator supercilii and orbicularis oculi muscles in addition to the contraction of the procerus muscle [ Figure 2 ]. [ 3 4 5 6 ] Procerus muscle originates in the nasal bone and inserts in the skin at the center of the forehead between the eyebrows. The procerus draws the medial angle of the eyebrows down, resulting in transverse wrinkling over the bridge of the nose.…”

“…The procerus draws the medial angle of the eyebrows down, resulting in transverse wrinkling over the bridge of the nose. [ 2 3 4 ] Corrugator supercilii pulls the eyebrows downward and medially, leading to the vertical wrinkling of the supranasal skin of the forehead. [ 4 5 ] This anatomical principle is the basis of surgical resection and chemodenervation of corrugator supercilii to treat vertical glabellar creases.…”

“…Batla et al used the term “vertical wrinkling of forehead” instead of the “Procerus sign” to describe the complex action of multiple forehead muscles generating this sign. [ 3 ] They showed that the prevalence of this sign was 75% in the PSP–Richardson subtype and 40% in the PSP–Parkinsonian subtype. “Procerus sign” is claimed to be an early and relatively specific clinical sign of PSP.…”