Vascular parkinsonism: a distinct, heterogeneous clinical entity.
OBJECTIVE
The aim of this study was to define the symptoms and signs of suspected vascular parkinsonism (VP) which is still a debatable concept.


METHODS
Patients with parkinsonism were grouped into patients with suspected VP and Parkinson's disease (PD) after other causes for secondary parkinsonism, and parkinsonism-plus syndromes were excluded. The clinical features of 16 patients with suspected VP to those of 50 diagnosed with PD were compared. All patients were assessed using unified Parkinson's disease rating scale (UPDRS) and all had cerebral MRIs.


RESULTS
Patients with VP had significantly older onset age and shorter duration of disease with gait disorder as the most frequent initial symptom. All PD patients had satisfactory response to levodopa treatment, whereas only 38% VP patients had satisfactory response to levodopa treatment. Vascular risk factors were more common in VP (81%) than PD (32%). Postural instability, freezing, gait disturbance, pyramidal signs, and postural tremor were significantly more prevalent in patients with VP than in PD. In VP patients these features were more prominent in the lower limbs. Twenty-five percent had acute onset VP. All patients with VP had ischemic lesions, mainly in subcortical white matter, to a lesser extent basal ganglia and brainstem, in their cerebral MRIs, while 70% of PD patients had normal MRIs.


CONCLUSIONS
The differences in the clinical features support the concept that VP is a distinct clinical entity with heterogeneous clinical, MRI, and possibly pathophysiological features.
Demirkiran
M
M
Cukurova University, School of Medicine, Department of Neurology, Adana, Turkey. eltemd63@yahoo.com
Bozdemir
H
H
Sarica
Y
Y
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D012307:Risk Factors; D014652:Vascular Diseases / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*