Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis

Abstract

Vascular parkinsonism (VP) is difficult to diagnose with any degree of clinical certainty. We investigated the importance of macroscopic cerebral infarcts and pathological findings associated with microscopic "small vessel disease" (SVD) in the aetiology of VP. The severity of microscopic SVD pathology (perivascular pallor, gliosis, hyaline thickening, and enlargement of perivascular spaces) and the presence of macroscopically visible infarcts were assessed in 17 patients with parkinsonism and no pathological evidence of either Parkinson's disease or any histopathological condition known to be associated with a parkinsonian syndrome, and compared with age-matched controls. Microscopic SVD pathology was significantly more severe in the parkinsonian brains. Most patients presented with bilateral bradykinesia and rigidity together with a gait disorder characterised predominantly by a shuffling gait. Four patients presented acutely with hemiparesis and then progressed to develop a parkinsonian syndrome. They could be distinguished from the remaining VP patients by the presence at autopsy of macroscopically visible lacunar infarcts in regions where contralateral thalamocortical drive might be reduced. The clinical features at presentation varied according to the speed of onset and the underlying vascular pathological state. New clinical criteria for a diagnosis of VP are proposed based on the clinicopathological findings of this study.

Vascular parkinsonism: a case series of 17 patients

“…The dementia is usually subcortical, manifesting as dysexecutive syndrome with impairment of attention, planning, judgment, goal-directed behavior, abstract thin king, verbal fluency, and apathy. Concomitant cognitive decline or dementia has already been reported by other authors 3,41,42 . In the Bambuí study 7 , eight (61.5%) of 13 patients with VP presented with the concomitant diagnosis of vascular dementia.…”

“…Patients had their diagnosis confirmed by applying the criteria of Zijlmans et al 3 . They were selected to participate in a structured interview to identify epidemiological and clinical data such as the age and mode of onset of their parkinsonism and dementia; its clinical course; the presence of comorbidities; past medical history (especially in regard to their past cerebrovascular event); family history; use of medication; presence of adverse medication effects; presence of levodopa fluctuations and dyskinesia; presence of visual hallucination; falls; urinary incontinence; freezing of gait (FOG); and difficulties in daily living activities.…”

Primary Progressive Freezing: does it stand on its own?

“…Lacunae and white matter lesions found in MRI studies are not specific and are common features in elderly individuals [15]. Two different sets of criteria were proposed for the diagnosis of Vascular Parkinsonism [16,17]. At this stage, our patient does not fulfil either of these criteria.…”

1.103 the Combination of Homocysteine and C-Reactive Protein Predicts the Outcomes of Chinese Patients With Parkinson's Disease and Vascular Parkinsonism

“…The patients were identified according to the United Kingdom PD Society Brain Bank (UK-PDSBB) criteria for the diagnosis of idiopathic PD [16]. In addition, 45 patients (23 males and 22 females) with VP and a mean age (6 SD) of 67.0611.6 (Table 1) were recruited according to the Zijlmans' criteria for the diagnosis of VP [17].…”