White Matter Hyperintensities in Parkinson's Disease

Piccini, Paola; Pavese, Nicola; Canapicchi, R.; Paoli, Claudio; Dotto, Paolo Del; Puglioli, Michele; Rossi, G; Bonuccelli, Ubaldo

doi:10.1001/archneur.1995.00540260097023

Cited by 108 publications

(93 citation statements)

References 20 publications

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“…This was observed in one patient in our study, but loss of response occurre d t h ree months after treatment began 4 , 1 2 , 1 8 . The lesions revealed in the exams of patients with PD did not alter disease evolution or the severity of the clinical symptoms as observed in another study 19 .…”

Section: Discussionsupporting

confidence: 70%

Vascular parkinsonism: analysis of seven cases

Silva

Viana

Quagliato

2006

Arq. Neuro-Psiquiatr.

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-I n t roduction: N e u roimaging studies of elderly individuals reveal alterations in the white matter that are incompatible with the patient's parkinsonism, mistakenly classified as vascular parkinsonism (VP). Method: This study was conducted on a population composed of 20 patients with Parkinson's disease (PD) whose neuroimaging exams revealed vascular alterations in the white matter and seven patients with VP in order to compare diagnostic criteria. Results: Age at disease onset of patients with PD was 5 5±12 years and patients with VP it was 62±13 years. Twelve patients with PD and five patients with VP presented arterial hypertension; three patients with VP and two patients with PD presented gait impairment; all patients with VP presented rigidity and bradykinesia, six of them presented resting tremor; 19 patients with PD presented tremor and 19 of them presented rigidity, while 17 presented bradykinesia. When the symptoms and evolution of both diseases were compared, the vascular alterations in the white matter were considered unspecific. Conclusion: Since clinical symptoms are unspecific, a diff e rential diagnosis requires neuroimaging, good response to levodopa and clinical evolution.KEY WORDS: vascular parkinsonism, Parkinson's disease, diagnosis, neuroimaging.Parkinsonismo vascular: análise de sete casos RESUMO -Introdução: Estudos de neuroimagem em idosos mostram alterações na substância branca que são incompatíveis com o parkinsonismo do paciente, erroneamente classificado como parkinsonismo vascular (PV). Método: Este estudo foi conduzido a partir de uma população de 20 pacientes com doença de Parkinson (DP) cujos exames de neuroimagem revelaram alterações vasculares na substância branca e sete pacientes com PV para comparar os critérios diagnósticos. Resultados: A idade de início da doença dos pacientes com DP foi 55±12 anos e pacientes com PV foi 62±13 anos. Doze pacientes com DP e cinco pacientes com PV apresentaram hipertensão arterial; três pacientes com PV e dois pacientes com DP apresentaram alteração da marcha; todos os pacientes com PV apresentaram rigidez e bradicinesia, seis deles a p resentaram tremor de repouso; 19 pacientes com DP apresentaram tremor e 19 deles apre s e n t a r a m rigidez, enquanto 17 apresentaram bradicinesia. Quando os sintomas e a evolução de ambas as doenças foram comparadas, as alterações vasculares na substância branca foram consideradas inespecíficas. C o nclusão: Como os sintomas clínicos são inespecíficos, um diagnóstico diferencial requer neuroimagem, boa resposta a levodopa e evolução clínica da doença. PALAVRAS-CHAVE: parkinsonismo vascular, doença de Parkinson, diagnóstico, neuroimagem.

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Section: Discussionsupporting

confidence: 70%

Vascular parkinsonism: analysis of seven cases

Silva

Viana

Quagliato

2006

Arq. Neuro-Psiquiatr.

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“…Some studies have suggested that WMHs are more common in patients with parkinsonism, 23,24 whereas others failed to demonstrate that. 25,26 Furthermore, in autopsy studies, only a small subset (,10%) of parkinsonism was attributed to vascular lesions, because of the absence of other pathologic findings (Lewy bodies or tau inclusions) compatible with a known parkinsonian syndrome.…”

Section: Resultsmentioning

confidence: 99%

Cerebral small vessel disease and incident parkinsonism

et al. 2015

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Objective: To investigate the relation between baseline cerebral small vessel disease (SVD) and the risk of incident parkinsonism using different MRI and diffusion tensor imaging (DTI) measures.Methods: In the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, a prospective cohort study, 503 elderly participants with SVD and without parkinsonism were included in . During follow-up (2011, parkinsonism was diagnosed according to UK Brain Bank criteria. Cox regression analysis was used to investigate the association between baseline imaging measures and incident all-cause parkinsonism and vascular parkinsonism (VP). Tract-based spatial statistics analysis was used to identify differences in baseline DTI measures of white matter (WM) tracts between participants with VP and without parkinsonism.Results: Follow-up was available from 501 participants (mean age 65.6 years; mean follow-up duration 5.2 years). Parkinsonism developed in 20 participants; 15 were diagnosed with VP. The 5-year risk of (any) parkinsonism was increased for those with a high white matter hyperintensity (WMH) volume (hazard ratio [HR] 1.8 per SD increase, 95% confidence interval [CI] 1.3-2.4) and a high number of lacunes (HR 1.4 per number increase, 95% CI 1.1-1.8) at baseline. For VP, this risk was also increased by the presence of microbleeds (HR 5.7, 95% CI 1.9-16.8) and a low gray matter volume (HR 0.4 per SD increase, 95% CI 0.2-0.8). Lower fractional anisotropy values in bifrontal WM tracts involved in movement control were observed in participants with VP compared to participants without parkinsonism. Cerebral small vessel disease (SVD) is a frequent finding on brain imaging of the elderly population 1 and has been identified as a cause of motor impairment 2 and gait and balance decline over time.3 SVD has also been related to parkinsonism, with evidence coming from crosssectional autopsy studies that found pathologic proof of SVD in patients with parkinsonism, who did not exhibit evidence of histopathologic findings compatible with parkinsonism, including Lewy bodies or tau inclusions. 4,5 Whether parkinsonism is a direct consequence of SVD or a coincidental finding is unknown.The imaging spectrum of SVD is rapidly expanding from lesions visible on conventional MRI, including white matter hyperintensities (WMHs), lacunes, microbleeds, and (sub)cortical

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“…Prevalence of vascular encephalopathy in PD patients ranges from 6% to 44% according to different series (Chang et al, 1992;Piccini et al, 1995;Jellinger et al, 2003), and similar prevalence rates have been found in other forms of parkinsonism, such as progressive supranuclear palsy (35%) (Dubinsky et al, 1987). 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).…”

Section: Vascular Pseudoparkinsonism (Vp)mentioning

confidence: 85%

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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White Matter Hyperintensities in Parkinson's Disease

Cited by 108 publications

References 20 publications

Vascular parkinsonism: analysis of seven cases

Vascular parkinsonism: analysis of seven cases

Cerebral small vessel disease and incident parkinsonism

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

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