Parkinsonism and basal ganglia infarcts

Tolosa, Eduardo; Santamaria, J. N.

doi:10.1212/wnl.34.11.1516

Cited by 99 publications

(61 citation statements)

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“…nvoluntary abnormal movements (IAMs) caused by strokes are relatively common, [1][2][3][4] and chorea, [3][4][5][6][7][8][9][10][11][12][13][14][15] tremor, [16][17][18][19][20][21][22][23][24][25][26][27][28][29] dystonia, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] parkinsonism, [44][45][46][47][48][49][50]…”

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confidence: 99%

Post-stroke movement disorders: report of 56 patients

Alarcón

2004

Journal of Neurology, Neurosurgery & Psychiatry

258

231

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Background: Although movement disorders that occur following a stroke have long been recognised in short series of patients, their frequency and clinical and imaging features have not been reported in large series of patients with stroke. Methods: We reviewed consecutive patients with involuntary abnormal movements (IAMs) following a stroke who were included in the Eugenio Espejo Hospital Stroke Registry and they were followed up for at least one year after the onset of the IAM. We determined the clinical features, topographical correlations, and pathophysiological implications of the IAMs. Results: Of 1500 patients with stroke 56 developed movement disorders up to one year after the stroke. Patients with chorea were older and the patients with dystonia were younger than the patients with other IAMs. In patients with isolated vascular lesions without IAMs, surface lesions prevailed but patients with deep vascular lesions showed a higher probability of developing abnormal movements. One year after onset of the IAMs, 12 patients (21.4%) completely improved their abnormal movements, 38 patients (67.8%) partially improved, four did not improve (7.1%), and two patients with chorea died. In the nested case-control analysis, the patients with IAMs displayed a higher frequency of deep lesions (63% v 33%; OR 3.38, 95% CI 1.64 to 6.99, p,0.001). Patients with deep haemorrhagic lesions showed a higher probability of developing IAMs (OR 4.8, 95% CI 0.8 to 36.6). Conclusions: Chorea is the commonest movement disorder following stroke and appears in older patients. Involuntary movements tend to persist despite the functional recovery of motor deficit. Deep vascular lesions are more frequent in patients with movement disorders.

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confidence: 99%

Post-stroke movement disorders: report of 56 patients

Alarcón

2004

Journal of Neurology, Neurosurgery & Psychiatry

258

231

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“…In addition, the presence of vascular encephalopathy, or even the existence of vascular risk factors, may aggravate the symptomatic picture in a patient with known PD (Papapetropoulos et al, 2004). The most relevant clinical characteristics of VP include: gait disorder, predominance in lower half of the body, postural instability, stiffness, pyramidal signs, and poor or no response to Ldopa (Tolosa et al, 1984;Trenkwalder et al, 1995), all of them occurring in a patient with evidence of cerebrovascular damage with no signs of other degenerative diseases, intake of antidopaminergic drugs, or hydrocephalus that could induce parkinsonism. Final diagnosis is made by post-mortem histological confirmation (absence of depigmentation or presence of Lewy bodies in substantia nigra) (Jellinger et al, 1996).…”

Section: Vascular Pseudoparkinsonism (Vp)mentioning

confidence: 99%

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

Castrejón¹,

Vicente²,

Romera³

et al. 2005

Braz. arch. biol. technol.

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123-I Ioflupane (Datscan®) presynaptic imaging has been shown to have a significant utility in the assessment of patients with movement disorders 123-I Ioflupane SPECT is able to distinguish between Parkinson's disease (PD) and other forms of parkinsonism without degeneration of the nigrostriatal pathway, including a common movement disorder such as essential tremor, and to assess disease progression in PD and other neurodegenerative disordersinvolving the substantia nigra.

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“…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%

“…Therefore, systematic studies are required to specify vascular lesions that are pathogenetically related to parkinsonism and to determine symptomatic and neuroimaging criteria for differentiating VP from IPD. The symptomatic characteristics of IPD are, in general, presence of 4- to 6-Hz resting tremor and cogwheel rigidity that are usually asymmetric and a clear response to L -dopa [25, 26], whereas those of VP are history of stroke [3], absence of tremor [1], absence of ‘true’ rigidity [27]and lack of response to L -dopa [3]. Furthermore, neuroimaging studies have reported that the width of the substantia nigra pars compacta (SNpc) was decreased in patients with IPD [28, 29, 30, 31]but not in patients with suspected VP [30].…”

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 and basal ganglia infarcts

Cited by 99 publications

References 0 publications

Post-stroke movement disorders: report of 56 patients

Post-stroke movement disorders: report of 56 patients

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

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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