Vascular <scp>P</scp>arkinsonism: <scp>D</scp>econstructing a <scp>S</scp>yndrome

Vizcarra, Joaquín A.; Lang, Anthony E.; Sethi, Kapil D.; Espay, Alberto J.

doi:10.1002/mds.26263

Cited by 93 publications

(78 citation statements)

References 45 publications

(79 reference statements)

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“…Neuroimaging studies in general fail to define a specific related pathology and describe rather non-specific findings such as diffuse subcortical white matter changes that may be associated with the so-called vascular parkinsonism as well as with gait and balance abnormalities in non-disabled elderly [62,68]. Conversely, typical MRI findings after methanol intoxication show structural damage of the basal ganglia [20,26,27] that was also demonstrated in one-third of the patients, including mainly bilateral putaminal necrosis and lesions in the pallidum [61,62]. However, we failed to find a statistically significant association between imaging findings and gait parameters in our group of patients.…”

Section: Discussionmentioning

confidence: 99%

Gait and Balance Impairment after Acute Methanol Poisoning

Peterová

Brožová

Klempíř

et al. 2017

Basic Clin Pharma Tox

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Neurological sequelae including gait impairment were reported in survivors after methanol intoxication; however, no systematic study has been published so far. We aimed to analyse gait and balance impairment in a group of Czech methanol poisoning survivors. We examined 43 patients (age 46 AE 13 years) 2-8 months after methanol poisoning and 43 healthy controls. Investigations contained a shortened version of Falls Efficacy Scale (FES), clinical tests of gait and balance including Timed Up and Go test (TUG) and gait analysis using GaitRite â system, neurological and neuropsychological examination, brain imaging, EMG and tests of alcohol consumption. Nineteen patients admitted balance and gait impairment according to FES. Mild to moderate parkinsonian signs showed seven patients. Patients were slower (8.8 versus 5.7 s, p < 0.001) and performed more steps (11.1 versus 7.9, p < 0.001) in TUG compared with the controls. Gait analysis revealed shorter step length (76.5 versus 88.7 cm, p < 0.001), increased double support phase (18.8 versus 15.5%, p < 0.001) and wider base of support (11.3 versus 9.6 cm, p = 0.006) in patients. Eleven patients had deficit of executive function and performed higher cadence compared to the patients with normal execution (122.7 versus 115.0 step/min., p = 0.025). Lower limb polyneuropathy was verified in nine patients, without relation with gait or balance parameters. Neuroimaging revealed lesions mainly in the basal ganglia. Methanol poisoning survivors presented slower wide-based gait with shortened steps corresponding with frontal gait disorder. Higher stepping cadence associated with executive deficit supported the evidence of frontal lobe dysfunction related to impairment of basal ganglia and connections in frontal cortico-basal ganglia loops.Methanol is a colourless liquid, resembling ethanol in smell and taste. Intoxications occur as isolated accidental episodes or as a mass or cluster poisonings due to consumption of illicit adulterated spirits [1][2][3]. In the Czech Republic, it was a rare condition until a mass poisoning outbreak in 2012-2014 with 137 intoxicated patients due to ingestion of adulterated alcoholic beverages [4,5]. The mortality and the prevalence of health sequelae in survivors were high despite efficient treatment [6][7][8][9].Absorption of methanol after oral administration is rapid with the attainment of peak methanol concentrations within 30-60 min. after ingestion. The minimal lethal dose of ingested methanol in adults is about 1 mg/kg of body-weight; however, the toxicity of methanol itself is relatively low. The products of biotransformation in the liver (formaldehyde and formic acid) in combination with metabolic acidosis are responsible for the major toxic effects in human beings [10][11][12]. The severity of clinical symptoms also depends on the concomitant amount of ingested ethanol due to competitive inhibition along the metabolic pathway [13,14].Acute symptoms of methanol intoxication usually develop after initial inebriety. The main compl...

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Section: Discussionmentioning

confidence: 99%

Gait and Balance Impairment after Acute Methanol Poisoning

Peterová

Brožová

Klempíř

et al. 2017

Basic Clin Pharma Tox

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“…At this stage, our patient does not fulfil either of these criteria. It is of note that this diagnosis has been questioned [18,19] and another entity was suggested-Vascular pseudoparkinsonism, a higher-level gait disorder (HLGD). One of the five subtypes initially proposed of HLGD was isolated gait ignition failure (IGIF), one of the names used as synonyms of PFP.…”

Section: Discussionmentioning

confidence: 99%

Primary Progressive Freezing: does it stand on its own?

Seabra¹,

Guimarães²,

Garrett³

2017

IJCNMH

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“…MRI excluded large strokes, masses, cerebellar, and brainstem atrophy or ventricular dilation not related to cortical atrophy (31). Individuals with large, space-occupying lesions on previous imaging or significant pyramidal weakness on exam were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism

et al. 2017

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The One-Leg Stance (OLS) test is a widely adopted tool for the clinical assessment of balance in the elderly and in subjects with neurological disorders. It was previously showed that the ability to control anticipatory postural adjustments (APAs) prior to lifting one leg is significantly impaired by idiopathic Parkinson’s disease (iPD). However, it is not known how APAs are affected by other types of parkinsonism, such as frontal gait disorders (FGD). In this study, an instrumented OLS test based on wearable inertial sensors is proposed to investigate both the initial anticipatory phase and the subsequent unipedal balance. The sensitivity and the validity of the test have been evaluated. Twenty-five subjects with iPD presenting freezing of gait (FOG), 33 with iPD without FOG, 13 with FGD, and 32 healthy elderly controls were recruited. All subjects wore three inertial sensors positioned on the posterior trunk (L4–L5), and on the left and right frontal face of the tibias. Participants were asked to lift a foot and stand on a single leg as long as possible with eyes open, as proposed by the mini-BESTest. Temporal parameters and trunk acceleration were extracted from sensors and compared among groups. The results showed that, regarding the anticipatory phase, the peak of mediolateral trunk acceleration was significantly reduced compared to healthy controls (p < 0.05) in subjects with iPD with and without FOG, but not in FGD group (p = 0.151). Regarding the balance phase duration, a significant shortening was found in the three parkinsonian groups compared to controls (p < 0.001). Moreover, balance was significantly longer (p < 0.001) in iPD subjects without FOG compared to subjects with FGD and iPD subjects presenting FOG. Strong correlations between balance duration extracted by sensors and clinical mini-BESTest scores were found (ρ > 0.74), demonstrating the method’s validity. Our findings support the validity of the proposed method for assessing the OLS test and its sensitivity in distinguishing among the tested groups. The instrumented test discriminated between healthy controls and people with parkinsonism and among the three groups with parkinsonism. The objective characterization of the initial anticipatory phase represents an interesting improvement compared to most clinical OLS tests.

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Vascular Parkinsonism: Deconstructing a Syndrome

Cited by 93 publications

References 45 publications

Gait and Balance Impairment after Acute Methanol Poisoning

Gait and Balance Impairment after Acute Methanol Poisoning

Primary Progressive Freezing: does it stand on its own?

Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism

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