Basal Ganglia Lacunes and Parkinsonism

Abstract

''Arteriosclerotic'' parkinsonism is still a subject of debate. The aim of this study was to investigate whether parkinsonism associated with basal ganglia lacunes possesses peculiar clinical features and a clinical course which enables its distinction from idiopathic Parkinson''s disease (IPD). 106 consecutive ambulatory patients with the clinical diagnosis of parkinsonism were referred for CT examination. Patients in whom isolated basal ganglia lacunes were found were interviewed and examined, and their clinical characteristics were compared to those of patients suffering from IPD without lacunes (controls). In 20 patients, isolated basal ganglia lacunes were detected; all had risk factors for stroke (significantly more than controls) and 7 of them had had clinically diagnosed strokes. The extrapyramidal disability evolved slowly in all. The clinical picture was indistinguishable from IPD in individual patients. However, tremor was significantly less frequent in this group. Lower body parkinsonism was not observed. Extrapyramidal signs were frequently asymmetrical (55%), with no consistent relationship to the side of the lacune. Asymmetrical pyramidal signs were present in 30% of those with unilateral lacunes, always on the appropriate side. Only 1 patient was an L-dopa nonresponder. Patients with parkinsonism associated with basal ganglia lacunes showed tremor less frequently than other IPD patients; otherwise, clinical features and course of the disease were indistinguishable from IPD. In these cases, parkinsonism and basal ganglia lacunes might have occurred independently of each other and tremor might have been prevented by ischemic events.

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

“…L -Dopa-responsive cases with vascular lesions in the absence of pathological changes in the SNpc [15]and, conversely, L -dopa-unresponsive cases with pathological changes in the SNpc [44]have been reported. Third, IPD symptoms may possibly be modified by a few, small ischemic lesions [21, 45, 46]. A study reported that parkinsonian symptoms did not differ between patients with and without isolated lacunes in the basal ganglia on computed tomography scans except for less frequent tremor in the former [45].…”

“…Third, IPD symptoms may possibly be modified by a few, small ischemic lesions [21, 45, 46]. A study reported that parkinsonian symptoms did not differ between patients with and without isolated lacunes in the basal ganglia on computed tomography scans except for less frequent tremor in the former [45]. In the present study, cases with only a few lacunes were included into the group without significant infarct because much higher sensitivity of MRI compared to computed tomography scans did not allow a clear-cut classification of individual cases into those with or without a few lacunes.…”

Parkinsonism in Patients with Vascular Dementia: Clinical, Computed- and Positron Emission-Tomographic Findings

“…Rest tremor of the upper limbs, that is frequently absent in VaP [7, 25, 28, 29], was present in 7 out of 10 patients. Gait disturbances that are considered to be prominent in VaP [7, 23, 25, 26, 27, 28, 29]were found in all our patients, except in 1.…”

“…Forty consecutive patients, admitted to the Neurological Department of the Ghent University Hospital with a diagnosis of ‘probable’ vascular dementia, according to the SCADDTC [46]and the NINDS-AIREN [7]criteria, were studied. All of them had a score of more than 7 points on the Hachinski’s ischemic scale [48].…”

“…Some authors argue that Parkinson’s disease and lacunar strokes frequently coexist and that the latter are not responsible for extrapyramidal features [2, 3, 4, 5, 6]. Cerebrovascular lesions are observed in 3–20% of all cases of Parkinson’s disease, either by neuroimaging or at autopsy [7, 8]. However, large consecutive autopsy series show that 2.5% of parkinsonian syndromes may be related to cerebrovascular disease without morphological signs of idiopathic Parkinson’s disease [9, 10].…”