Parkinsonism due to a basal ganglia lacunar state

Murrow, Richard W.; Schweiger, Gary D.; Kepes, John J.; Koller, William C.

doi:10.1212/wnl.40.6.897

Cited by 92 publications

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“…The exact pathophysiological mechanisms leading to VP are unknown, although diffuse white matter lesions may damage the net thalamocortical loop, thereby decreasing the ultimate influence of the basal ganglia on higher centers of motor planning and execution. All the same, strategic infarcts would cause parkinsonism by disrupting the putamino-pallido-thalamic loop 1,35 . Notwithstanding the clinical variability, neuroimaging is also problematic.…”

Section: Discussionmentioning

confidence: 99%

Vascular parkinsonism: a case series of 17 patients

Vale

Caramelli

Cardoso

2013

Arq. Neuro-Psiquiatr.

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Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.

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Section: Discussionmentioning

confidence: 99%

Vascular parkinsonism: a case series of 17 patients

Vale

Caramelli

Cardoso

2013

Arq. Neuro-Psiquiatr.

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“…Although the majority of the patients with PD p resented vascular lesions in the periventricular white m a t t e r, lesions were also found in the basal nuclei and subcortical white matter, which made it a comp l e m e n t a ry exam in the etiology of the conditionuseful for the confirmation and localization of vascular lesions and exclusion of other causes for symptom a t o l o g y, but didn't help in obtaining a diff e re n t i a l diagnosis for PD and VP 2,4,12,20 .…”

Section: Discussionmentioning

confidence: 99%

Vascular parkinsonism: analysis of seven cases

Silva

Viana

Quagliato

2006

Arq. Neuro-Psiquiatr.

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-I n t roduction: N e u roimaging studies of elderly individuals reveal alterations in the white matter that are incompatible with the patient's parkinsonism, mistakenly classified as vascular parkinsonism (VP). Method: This study was conducted on a population composed of 20 patients with Parkinson's disease (PD) whose neuroimaging exams revealed vascular alterations in the white matter and seven patients with VP in order to compare diagnostic criteria. Results: Age at disease onset of patients with PD was 5 5±12 years and patients with VP it was 62±13 years. Twelve patients with PD and five patients with VP presented arterial hypertension; three patients with VP and two patients with PD presented gait impairment; all patients with VP presented rigidity and bradykinesia, six of them presented resting tremor; 19 patients with PD presented tremor and 19 of them presented rigidity, while 17 presented bradykinesia. When the symptoms and evolution of both diseases were compared, the vascular alterations in the white matter were considered unspecific. Conclusion: Since clinical symptoms are unspecific, a diff e rential diagnosis requires neuroimaging, good response to levodopa and clinical evolution.KEY WORDS: vascular parkinsonism, Parkinson's disease, diagnosis, neuroimaging.Parkinsonismo vascular: análise de sete casos RESUMO -Introdução: Estudos de neuroimagem em idosos mostram alterações na substância branca que são incompatíveis com o parkinsonismo do paciente, erroneamente classificado como parkinsonismo vascular (PV). Método: Este estudo foi conduzido a partir de uma população de 20 pacientes com doença de Parkinson (DP) cujos exames de neuroimagem revelaram alterações vasculares na substância branca e sete pacientes com PV para comparar os critérios diagnósticos. Resultados: A idade de início da doença dos pacientes com DP foi 55±12 anos e pacientes com PV foi 62±13 anos. Doze pacientes com DP e cinco pacientes com PV apresentaram hipertensão arterial; três pacientes com PV e dois pacientes com DP apresentaram alteração da marcha; todos os pacientes com PV apresentaram rigidez e bradicinesia, seis deles a p resentaram tremor de repouso; 19 pacientes com DP apresentaram tremor e 19 deles apre s e n t a r a m rigidez, enquanto 17 apresentaram bradicinesia. Quando os sintomas e a evolução de ambas as doenças foram comparadas, as alterações vasculares na substância branca foram consideradas inespecíficas. C o nclusão: Como os sintomas clínicos são inespecíficos, um diagnóstico diferencial requer neuroimagem, boa resposta a levodopa e evolução clínica da doença. PALAVRAS-CHAVE: parkinsonismo vascular, doença de Parkinson, diagnóstico, neuroimagem.

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“…In particular, the nigrostriatal dopaminergic nerve terminals within the striatum are highly vulnerable to ischemia [11], and the concentration of L -dopa is reduced in the cerebrospinal fluid from patients with suspected VP as well as IPD [63]. This may in part explain the initial transient response to L -dopa in some present patients with SLP or CWMH without 4- to 6-Hz tremor and cogwheel rigidity and in reported cases with vascular lesions without evidence of coexistent IPD at autopsy [6, 15, 44]. On the other hand, parkinsonism in cases with CWMH may be produced through disconnection of the basal gray matter (corticostriatal and thalamocortical tracts) and cerebellum from the supplementary motor area [18]as has been assumed in cases with hydrocephalus [64, 65]and Binswanger’s disease [18, 66].…”

Section: Discussionmentioning

confidence: 99%

“…In 1929, Critchley [1]designated such cases as ‘arteriosclerotic parkinsonism’, reporting its clinical characteristics as compared to idiopathic Parkinson’s disease (IPD) consisting of rapid progression, symmetrical symptoms, absence of tremor and plastic rigidity instead of cogwheel rigidity. While he related the symptoms to vascular changes in the globus pallidus and, to a lesser extent, the substantia nigra, later autopsy- or neuroimaging-based studies have related parkinsonism to symmetrical vascular lesions in the putamen [2, 3, 4, 5, 6, 7]or cerebral white matter [8, 9, 10]. Experimental and human autopsy studies have demonstrated that dopaminergic nerve terminals [11], GABA/substance P neurons (which give rise to the indirect pathway [62]) [12], dopamine receptors [13]and nicotinic acetylcholine receptors [14]in the striatum are highly vulnerable to ischemia, which may result in an increased susceptibility to parkinsonism.…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Characteristics of Parkinsonism and the Width of Substantia nigra pars compacta on MRI According to Ischemic Changes in the Putamen and Cerebral White Matter: Implications for the Diagnosis of Vascular Parkinsonism

Tohgi

Takahashi²,

Abe³

et al. 2001

Eur Neurol

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To investigate the significance of vascular lesions as a cause of secondary parkinsonism, we analyzed the symptomatic characteristics, the width of the substantia nigra pars compacta (SNpc) on MRI and the responsiveness to L-dopa in 227 parkinsonian cases, excluding those with drug-induced parkinsonism and neurodegenerative diseases other than idiopathic Parkinson’s disease (IPD). They were classified into those without a significant infarct in the basal ganglia (n = 144), those with status lacunaris in the putamen (SLP; n = 66) and those with confluent white matter hyperintensity signals (CWMH; n = 17). The 4- to 6-Hz tremor and cogwheel rigidity were significantly more frequent in cases without significant infarct (69%) than those with SLP (50%) and those with CWMH (12%; p < 0.05). Among cases with 4- to 6-Hz tremor and cogwheel rigidity, the frequency of patients with a reduced SNpc width and L-dopa responders did not significantly differ between those with SLP (73 and 83%, respectively) and those without significant infarct (83 and 86%, respectively), suggesting that the diagnosis for most of these cases would be probable IPD. In contrast, among cases without 4- to 6-Hz tremor and cogwheel rigidity, those with a reduced SNpc width or L-dopa responders were significantly less frequent among cases with SLP (25 and 38%, respectively) than among those without significant infarct (75 and 71%, respectively; p < 0.05). Patients with neither 4- to 6-Hz tremor and cogwheel rigidity nor reduction in the SNpc width, for whom the probable diagnosis was vascular parkinsonism (VP), were significantly more frequent in cases with SLP (26%) and with CWMH (40%) than those without significant infarct (8%), accounting for 10.6% of the total parkinsonian cases. These findings suggest that parkinsonian cases with SLP or CWMH consist of not only cases with vascular-lesion-related VP but also IPD in which vascular lesions are not directly related to parkinsonism. Absence of 4- to 6-Hz tremor, cogwheel rigidity and the reduction in the SNpc width could be indicators for differentiating VP from IPD.

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Parkinsonism due to a basal ganglia lacunar state

Cited by 92 publications

References 0 publications

Vascular parkinsonism: a case series of 17 patients

Vascular parkinsonism: a case series of 17 patients

Vascular parkinsonism: analysis of seven cases

Symptomatic Characteristics of Parkinsonism and the Width of Substantia nigra pars compacta on MRI According to Ischemic Changes in the Putamen and Cerebral White Matter: Implications for the Diagnosis of Vascular Parkinsonism

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