Symptoms:

• Changes in expressions of the face
• Deeply lined face
• Different size pupils
• Difficulty swallowing
• General slowness of movement (bradykinesia)
• Jaw or face jerks or spasms
• Loss of coordination, unsteady gait (walking pattern)
• Mild dementia
  • Difficulty using knowledge
  • Forgetfulness
  • Indifference (apathy)
  • Slowed thought processes
• Pain or difficulty with bending the neck up or down
• Personality changes
• Repeated falls
• Slow or stiff movements
• Speech difficulties
  • Low voice volume
  • Poor ability to speak clearly (enunciate)
  • Slow speech
• Stiffness and rigid movement in the neck, middle of the body, arms, legs
• Tremor
• Uncontrollable eye movements
• Vision difficulty -- unable to look up or down without bending the neck

Signs and tests:

An exam of the nervous system (neurological examination) may show:

• Limited eye movements
• Mild dementia
• Normal vision, hearing, sensation, and voluntary control of movement
• Stiff and uncoordinated movements like those of Parkinson's disease

The health care provider may do tests to rule out other diseases. Magnetic resonance imaging (MRI) might show shrinking of the brainstem.