A patient with a mood disorder and a Parkinsonian syndrome with frontal 
cognitive impairment thought to resemble progressive supranuclear palsy defied 
precise diagnosis until the development of respiratory compromise, prompting 
consideration of the diagnosis of Perry syndrome. A mutation in the dynactin 1 
gene confirmed the diagnosis. Few examples of this disorder, characterised by 
depression, Parkinsonism, and respiratory insufficiency, have been reported but 
it may be more commonly recognised with the availability of genetic testing. 
Perry syndrome needs to be considered in the differential diagnosis of 
Parkinsonism, particularly in autosomal dominant pedigrees. Diagnosis early in 
the disease course may facilitate monitoring and prompt intervention to avoid 
potentially fatal respiratory failure.