Vascular Parkinsonism: A Review of the Precision and Frequency of the Diagnosis

Abstract

Over the past century vascular parkinsonism (VP) has been established, dismissed and recently re-established as a possible clinical entity. We review the clinical features that have been proposed to suggest the diagnosis and explore how precisely VP has been defined on the basis of clinical, as well as radiological and pathological grounds. Estimates of the frequency of this condition have been based on population-based incidence and prevalence studies and also using case series of all types or parkinsonism. We performed a systematic search for all of these published studies and present their estimates of frequency. We conclude that the wide variations in these estimates may be largely explicable by variation in case definition. When studies are limited to those with either imaging or pathological support for the diagnosis, all but one estimate that 3–6% of all cases of parkinsonism have a vascular cause. In addition, features of parkinsonism have been seen in up to 38% of lacunar stroke patients at 1 year. On the basis of this appreciably high frequency, and with consideration of the implications for clinician and scientist, we suggest that VP needs to be recognised as an important clinical diagnosis, and includes a spectrum of distinct pathophysiological entities.

Venous Hypoxia: A Poorly Studied Etiological Factor of Varicose Veins

“…Increased intracellular calcium concentration has also been shown in hypoxic venous endothelial cells, leading to activation of phospholipid A 2 and elevated prostaglandin synthesis [45,46]. Alteration of these cellular processes is thought to cause the release of inflammatory mediators [47]. Activation of venous endothelial cells by hypoxia also increases the release of β-fibroblast growth factors (bFGF) and prostaglandin F 2 α, which are known to stimulate smooth muscle cell migration and proliferation, a feature commonly observed in varicosities [6,46,48].…”

Das vaskuläre Parkinson-Syndrom

“…B. in Anlehnung an die UK "brain bank criteria" [11]) definiertes VPS nach klinikopathologischen und epidemiologischen Studien nur ca. 3-6 aller Parkinson-Syndrome ausmacht [18]. Im Gegensatz hierzu stellen die mit subkortikaler arteriosklerotischer Enzephalopathie (SAE) assoziierten Gangstö-rungen, die bei Fehlen weiterer Kardinalsymptome nicht als VPS bezeichnet werden sollten, ein häufiges Phänomen des höheren Lebensalters dar [19,20,21].…”

123-I ioflupane (Datscan®) presynaptic nigrostriatal imaging in patients with movement disorders

“…Approximately 3% to 6% of all cases of parkinsonism may have a vascular cause (Foltynie et al, 2002;De Rijk et al, 1997). In Spain, a prevalence of 2.5% of all patients with parkinsonism has been found (Benito-León et al, 2003).…”